Case Studies Flashcards
A patient enters your clinic with a referral for carpal tunnel syndrome. Upon evaluation, the patient is positive for ULTT A, the upper/mid thoracic region is found be stiff, and the patient has pain that refers into their neck and head. What is their likely diagnosis?
T4 syndrome.
What type of intervention is supported by the literature for T4 syndrome?
Upper T-spine manips.
A patient enters the clinic with a main complaint of back pain when leaning over. During the exam, a prominence is felt in the mid left thoracic spine while the patient is flexed forward. What is the patient’s diagnosis? What is their treatment?
- ERSL lesion
- Treat using T-spine MET in FRSR
A patient presents with complaints of pain in the cervical region that began 2 weeks ago. Upon examination, the patient is limited in extension, but is pain free. What is their classification, and what is their treatment?
- T-spine hypomobility with Neck pain
- Treat with thoracic 6 thoracic manips followed by active ROM with a tucked chin
A patient presents to the clinic with a headache that has been a problem for them over the last 4 months. The headache is bilateral, doesn’t increase with physical activity, and is described as a pressing or tightening pain. What is their probable diagnosis, what is their treatment?
- Neck pain with headache
- If headache is 8.5 hours per day and less than 6 days a week, trigger point will be helpful.
- May also perform strain-counterstrain, MET
A patient presents to the clinic after with LBP after performing an awkward movement during tennis. They injured themselves 1 week ago, L3 was found to be hypomoble, and the patient is not exeperiencing symptoms distal to their knee. What is their probable diagnosis? What is their treatment?
- L-spine manipulation classification
- Manips followed by active ROM
ex)
- cat/ camel
- neutral crunch
- side planks
- quadriped arms and legs
A young patient presents to clinic with a recent history of LBP with a medical history of spondylolisthesis. The patient shows no signs of neurological involvement, and bent over to tie his shoes in an unusual way. What is his likely diagnosis? What is his treatment?
- Stabilization classification
- FR training
A patient presents to the clinic with pain in their jaw that is tender to palpation on the lateral condyle, pain when eating food, and pain with accessory motion overpressure. What is their likely diagnosis? What is their treatment?
- Capsulitis/ Synovitis of the TMJ
- Treat with soft tissue work on the muscles of mastication
- Mobs/ HVLAs of TMJ, C/T-spine
- Iontophoresis
- Postural/ Proprioception exercise
A patient presents to clinic with pain during chewing of food. You notice them chewing their nails during the examination, and notice that their open and close their mouths in an unusual pattern. What is their likely diagnosis? What is their treatment?
- Disorder of muscles of mastication
- Heat to begin treatment
- Controlled opening/ closing
- Stretching
- Soft tissue mobilization
- Patient education/ activity modification
If you suspect that a patient may have TOS, or if they have shoulder girdle pain, what are some appropriate tests?
- Cervical rotation with lateral flexion
- 1st rib spring
(hyperabudction/ roo’s, all that stuff too)
A patient presents to the clinic with a complaint of LBP with some referred pain into their LEs. You perform repeated standing extension movements, and the pain centralizes somewhat, but the pain intensity increases. What is their diagnosis? What is their treatment?
- Specific Exercise L-spine classification
- Correct lateral shift
- Prone extension exercises
- Increase ROM/ force
- Add mobilizations
A patient presents with complaints of a clicking when they open their jaw. You notice they have excessive mouth opening. What is their probable diagnosis? What is their treatment?
- TMJ hypermobility
- Educate to prevent excessive opening
(tongue on roof of mouth when yawning) - Proprioceptive exercises
- Stabilization exercises
A patient presents with complaints of pain in their jaw. On examination, you notice that their mouth opens abnormally, and there a click is present on mouth closing. What is their probable diagnosis? What is their treatment?
- TMJ Articular Disc Displacement with reduction
- TMJ mobilizations
- TrP and Positional release
- Postural ROM
- Isometric stabilizations
- Possibly refer out for splinting
A patient presents with complaints of pain in their posterior shoulder. The upper/middle T-spine is found to have stiff segmental movements. The patient has difficulty lifting their arms overhead, but it becomes easier when they retract their scapulae. The patient is positive for the empty can test. What is their likely diagnosis? What is their treatment?
- T-spine hypomobility with Shoulder Impairments with early signs of RC impingement
- Mob/ manip the T-spine
- Postural reeducation
- Movement training
- RC strengthening/ stretching
- Joint mobs for pain relief
A patient presents with complaints of LBP. The patient has forward head posture. On examination, the patient’s lower T-spine has stiff segments. What is their likely diagnosis? What is their treatment?
- T-spine hypomobility with LBP
- Manip T-spine
- Posture reeducation
