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NCBI: db=pubmed; Term=("The Journal of orthopaedic and sports physical therapy"[Jour])



 



Differential Diagnosis in a Patient Presenting With Both Systemic and Neuromusculoskeletal Pathology: Resident's Case Problem.

Differential Diagnosis in a Patient Presenting With Both Systemic and Neuromusculoskeletal Pathology: Resident's Case Problem.

J Orthop Sports Phys Ther. 2018 Feb 06;:1-8

Authors: Petersen EJ, Thurmond SM

Abstract
Study Design Resident's case problem. Background Patients presenting with multiple symptomatic areas pose a diagnostic challenge for the physical therapist. Though musculoskeletal and nonmusculoskeletal symptoms typically present separately, they can occur simultaneously and mimic each other. Consequently, the ability to differentiate between musculoskeletal and nonmusculoskeletal symptoms is an important skill for physical therapists. The purpose of this resident's case problem was to describe the clinical-reasoning process leading to medical and physical therapy management of a patient presenting with upper and lower back pain, bilateral radiating arm and leg pain, and abdominal pain. Diagnosis The patient was a 30-year-old woman referred to physical therapy for upper and lower back pain. A detailed history and thorough examination revealed that the patient had signs and symptoms consistent with a possible abdominal aortic aneurysm. She was referred for medical management and was diagnosed with symptomatic cholelithiasis. She subsequently had a cholecystectomy, which ultimately resolved her abdominal pain and reduced her pain in other areas significantly. Although many of her symptoms resolved postoperatively, her pain in other areas remained and was potentially musculoskeletal in origin. Following re-evaluation and 3 physical therapy treatments over a 2-month period, she was relatively symptom free at discharge and had achieved all functional rehabilitation goals. Discussion This resident's case problem provides an opportunity to discuss the differential diagnosis, clinical reasoning, and outcome of a patient who presented with both systemic and neuromusculoskeletal pathology. Level of Evidence Differential diagnosis, level 5. J Orthop Sports Phys Ther, Epub 6 Feb 2018. doi:10.2519/jospt.2018.7652.

PMID: 29406836 [PubMed - as supplied by publisher]




Pragmatically Applied Cervical and Thoracic Nonthrust Versus Thrust Manipulation for Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial.

Pragmatically Applied Cervical and Thoracic Nonthrust Versus Thrust Manipulation for Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial.

J Orthop Sports Phys Ther. 2018 Feb 06;:1-30

Authors: Griswold D, Learman K, Kolber MJ, O'Halloran B, Cleland JA

Abstract
Study Design Randomized clinical trial. Background The comparative effectiveness between non-thrust (NTM) and thrust manipulation (TM) for mechanical neck pain has been investigated with inconsistent results. Objective To compare the clinical effectiveness of concordant cervical and thoracic NTM and TM for patients with mechanical neck pain. Methods The Neck Disability Index (NDI) was the primary outcome. Secondary outcomes included the Patient Specific Functional Scale (PSFS), Numerical Pain Rating Scale (NPRS), deep cervical flexion endurance (DCF), Global Rating of Change (GROC), number of visits, and duration of care. Covariates were clinical equipoise for intervention. Outcomes were collected at baseline, visit 2, and discharge. Patients were randomly assigned to receive either NTM or TM directed at the cervical and thoracic spines. Techniques and dosages were selected pragmatically and applied to the most symptomatic level. Two-way, repeated measures Analysis of Covariance (ANCOVA), were used to analyze clinical outcomes at three time points. ANCOVAs analyzed between-group differences for GROC, number of visits, and duration of care at discharge. Results One hundred and three patients were included in the analyses (N=55 NTM and N=48 TM). The between group analyses revealed no differences on the NDI (P=.67) PSFS (P=.26), NPRS (P=.25), and DCF (P=.98) or for the GROC (P=.77), number of visits (P=.21), and duration of care (P =.61), for patients with mechanical neck pain who received either NTM or TM. Conclusion NTM and TM produce equivalent outcomes for patients with mechanical neck pain. Level of Evidence Level 1b. J Orthop Sports Phys Ther, Epub 6 Feb 2018. doi:10.2519/jospt.2018.7738.

PMID: 29406835 [PubMed - as supplied by publisher]