DIAGNOSIS GAME #2...CLICK HERE DIAGNOSIS GAME #1 Submitted by a McKenzieStudy Member Click to see ANSWER/DISCUSSION/REFERENCES of the dx game (provided by the same McKenzieStudy Member.) Subjective data Age: 60 year old male Occupation: plumber Postures stresses: bending, twiSting, crawling, lifting Off work: no Relevant symptoms: Constant back pain. Constant left back, buttock, thigh and leg pain. Tingling into outer 3 toes Leg pain is more severe than back. back pain has been present for many years. Not worse this episode Onset: 1 year history of severe leg pain. Unchanging past several months Commenced as a result of: no apparent reason Symptoms at onset: same Worse: bending, sitting, walking, lying -- all make him temporarily worse but symptoms settle back to base line relativley quickly. No varaition in lumbar ROM with pain Better: Lying -- temporary. Change in positions--temporary. AM: worse rising, better as day progresses Disturbed sleep: yes Cough/sneeze/strain: negative Bladder: normal Gait: limps a little on left leg. No tripping, stumbling Previous episodes: Multiple episodes of back pain and left leg pain over the years. Leg pain has alsways resolved. Reports constant back pain x years. Treatment: this episode chriopractic manipulation: no help X-rays: not this episode. MRI 2 years ago bony changes at L4-5 and L5-S1-- no report available Gen Health: Type II diabetes Meds: Glyburide: Tylenol as required Recent surgery: no Accidents: no Weihgt loss: no First question, previously posted, was: Question: based on the subjective data what would be your provisional hypothesis. List what it is not (giving reasons) and then list what you cannot rule out (give reasons). Would your hypothesis change your mechanical testing procedures? Eval! Slouched sitting during history: increased left leg pain. sitting erect: no change. Posture sitting= poor, standing = poor; lordosis =m reduced; lateral shift = nil Movement loss: Flex: min; no deviation Extension: major, no deviation (patient reports no relevant loss in ext ROM this episode, longstanding) Side glide: right=left= min, able to cross midline both sides. Test Movements: Standing: Standing symptoms: left leg pain, tingling outer toes FIS: inc left leg RFIS: Increased, not worse(no change in flexion or extension ROM after) EIS: Increased REIS: Increased, no worse Lying symptoms: left leg pain, tingling in toes FIL: NE RFIL: Increased left leg, no worse (no change in ROM) EIL: Increased left leg REIL: Increased, worse (no changes in ROM) Neuro: strength: within normal limits all myotomes reflexes intact SLR: left 70 degres (increased thigh discomfort); right 70 degrees. Question: Based on your hypothesis from the subjective and these exam findings what would be your conclusion (provide reasons). Dose this patient require further mechanical evaluation? If so, what would you do and how would that help? Do you think this patient will respond to mechanical therapy? If so, what would be your principle of treatment? |