Objective: The objective of this study is to highlight the importance of differential diagnosis in physical therapy when approaching a patient suffering with low back pain. Although serious diseases related to the spine represent only 1% of patients with LBP, it is necessary for physical therapist to be able to find and locate signs and symptoms expression of important issues. The aim of physiotherapy differential diagnosis is the result of a complex process of clinical reasoning and decision making. Method: The patient has been sent to physical therapy by physician with a diagnosis of LBP: AF, woman, 42 years old, 60 kg for 1.50 m high, BMI: 26.7, housewife, married with two daughters. She referred pain localized in the left thoracolumbar area with front radiation to the navel. She began about a month ago with no apparent causes, with a VAS 3/10 but increased to 8–9/10. The pain continues even at night disturbing sleep and defecting to carry out daily house activities. Starting from this basic informations a complete assessment has been performed, along with a thorough history and physical examination. Results: According to the case history data the red flags LBP diagnosis are: unintentional weight loss of 5 kg (in the last 2 months), hypertension, abnormal ESR, family history of cancer. Physical examination confirmed this strong suspicion, so the patient was sent back to the physician. Subsequently, the patient performed an ultrasound followed by a CT scan which confirmed the presence of left renal cancer removed by laparoscopic surgery enucleoresection. Implications/ Impact on Rehabilitation: As we analyzed in this case report, it is essential before starting treatment to exclude any serious medical condition needing a specialistic diagnosis. Close cooperation between physician and physical therapist can drastically help the therapeutic course and the positive outcome of the patient.
Differential Diagnosis in physical therapy and physical examination of patient with referral with low back pain : Cancer of kidney case report
Maselli F;
2011-01-01
Abstract
Objective: The objective of this study is to highlight the importance of differential diagnosis in physical therapy when approaching a patient suffering with low back pain. Although serious diseases related to the spine represent only 1% of patients with LBP, it is necessary for physical therapist to be able to find and locate signs and symptoms expression of important issues. The aim of physiotherapy differential diagnosis is the result of a complex process of clinical reasoning and decision making. Method: The patient has been sent to physical therapy by physician with a diagnosis of LBP: AF, woman, 42 years old, 60 kg for 1.50 m high, BMI: 26.7, housewife, married with two daughters. She referred pain localized in the left thoracolumbar area with front radiation to the navel. She began about a month ago with no apparent causes, with a VAS 3/10 but increased to 8–9/10. The pain continues even at night disturbing sleep and defecting to carry out daily house activities. Starting from this basic informations a complete assessment has been performed, along with a thorough history and physical examination. Results: According to the case history data the red flags LBP diagnosis are: unintentional weight loss of 5 kg (in the last 2 months), hypertension, abnormal ESR, family history of cancer. Physical examination confirmed this strong suspicion, so the patient was sent back to the physician. Subsequently, the patient performed an ultrasound followed by a CT scan which confirmed the presence of left renal cancer removed by laparoscopic surgery enucleoresection. Implications/ Impact on Rehabilitation: As we analyzed in this case report, it is essential before starting treatment to exclude any serious medical condition needing a specialistic diagnosis. Close cooperation between physician and physical therapist can drastically help the therapeutic course and the positive outcome of the patient.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
