Physical therapy (Differential Diagnosis)

Questions: 1. How would you have assessed this patient's supposed low back muscle strain to confirm this was the cause or origin of the patient's extreme low back and right flank pain, with the patient unable to tolerate a reassessment? 2. Based upon this patient's extensive medical history, would you suspect possible renal involvement? If so what might be the likely cause?3. Are there clinical signs or symptoms that could differentiate flank or back pain coming from an upper urinary infection verses that of pain from cystitis or urethritis complications? 4. Do you think that pain in the low back and radiating around the front lower abdominal quadrant could have been caused solely by referred pain from the renal system? List and discuss other possibilities. 5. Identify an impairment, activity limitation, and participation restriction for this patient. Additional questions: Please refer to chapter readings. 6. What may be the first symptom of prostate cancer in a male? 7. List and discuss at lea st four of the eight other causes described in chapter 10 for incontinence (worth 4 points). 8. Renal pain is typically felt in two regions of the body. Describe where the two regions are. According to your textbook, how is renal pain typically described? 9. How does a physical therapist screen for possible prostate involvement in a man with back pain of unknown causes? Answers: 1. There are symptoms which are similar to low back strain (Hoy et al., 2014). The pain in the patient is localized in the lower back it may arise due to some serious illness. Here are the symptoms which are a weakness in the leg. Incontinence or inability to control flow of urine is a symptom which the patient is facing now. The patient was finding it difficult on standing or walking. There is stiffness in the back which is evident by the inability of the patient to move. 2. There is a possibility of kidney involvement in this patient. As the patient is diabetic (type II) for 11 years it is possible nephrosclerosis that is hardening of small blood vessel in the kidney. According to Yale et al., (2013) patient is initially diagnosed with high blood pressure. Patient with hypertensive nephrosclerosis can lead to end-stage renal disease. Patient with type 2 diabetes can also suffer from kidney failure in later stage. Patient also has a history of kidney stone which is also supported by the right flank pain after the physical therapy. Finally, the X-ray report did not reveal any cause. 3. Cystitis refers to the inflammation of urinary bladder especially the bladder wall (Conover et al., 2014). This is a kind of lower urinary tract infection. Lower urinary tract is composed of bladder and urethra. Though it can happen in both the sex, it is more prevalent among females. Lower urinary tract infection or cystitis or urethritis is pain is characterized by burning pain during urination. Urethritis is caused by bacterial infection. Upper urinary tract comprises of kidney and ureter. In case of upper urinary tract infection, the pain and tenderness are found on upper back and sides. 4. Low back pain and radiating pain in right lower abdominal quadrant may be due to causes other than referred pain of renal system (Tozzi et al., 2012). As the patient is male in this, we can exclude the other causes which have the similar kind of pain like ectopic pregnancy and cysts in the right ovary. The right abdominal pain may be due to an inflamed appendix which is the most common cause of such type of pain. In this case, pain became more intense with time and tenderness on touching is an indication of inflamed appendix. Constipation is another possibility that can lead pain in low back and radiating pain in right lower abdomen. 5. A difficulty in body function or structure is called impairment. In this scenario the patient movement is restricted within 10 feet due to shortness of breath identifies an impairment of pulmonary function. Activityis defined as the execution of a task or action by an individual. When an individual execute a task or action it can be called as activity. When a person is unable to do that activity personally it is activity limitation. The patient became dependent for rolling, lying face upward and standing which identifies the activity limitation. Patient planned to return home and join family after physical therapy, but he was unable to do so as the condition deteriorate. This identifies the participation restriction for this patient. 6. First symptom of prostate cancer in male: Prostate is located adjacent to urinary bladder. It is not essential that everyone will face the experience the symptoms of prostate cancer (Moyer, 2012). Detection of sign occurs mostly at the time of routine doctor visit. The early symptoms include: Frequent urge for urination at night. Difficulty in urination and holding it back. Burning sensation during urination. Difficulty in getting an erection and ejaculation. Presence of blood in urine. Pain in hips and legs. 7. Causes of incontinence: Urinary is the leakage of urine without intention. By losing the voluntary control of muscle involved in holding the urine in bladder patient develop incontinence. Urge Incontinence: Urge incontinence is most prevalent in older patient. The characteristic of urge incontinence is leakage of urine. Interstitial cystitis, spinal cord injury are also considered as cause of urinary urge incontinence. Old age: Strength of muscle in bladder and urethra decrease with age and urge for urination increases with time which cause in incontinence. Pelvic floor muscle exercise are generally recommended for those who have renal incontinence. Overflow: Old age men often suffer from prostate gland problem. Enlarged prostate often creates an obstruction due to which patient never can urinate fully. In some patient, it has been found that they continuously trickle. Stress: Women after pregnancy or after menopause face this problem. This problem happens in women due to insufficient estrogen and muscular atrophy. People who have undergone prostate surgery or suffering from enlarged prostate can also build up this problem. 8. Localization of kidney pain is difficult exactly as kidney is retroperitoneal organ. Most of the time kidney pain diffuse or radiate from the site of origin (Walsh Sarria 2012). Kidney pain is located in right and left upper quadrant of body. Right upper quadrant is right upper abdominal region. Lower right part of the ribcage protects this organ. Left upper quadrant is the left upper abdominal region. Description of renal pain: According to Becquemont et al., (2015), kidney pain is defined as pain arising from kidney due to infection, inflammation or physical injury. Kidney pain is typically characterized by dull, single sided pain in upper quadrant of the body. Fever and urinary symptoms may accompany with pain. 9. Screening for possible prostate involvement in a man with back pain of unknown cause by a physiotherapist: As discussed by Van Kampen et al., (2015) back pain may be due to various causes. It may due to fracture, cancer or neurological disorders or it may be due to infection. To find out the prostate involvement physiotherapist may follow this steps: Functional tests- which demonstrates the pain-provoking movement. Movement testing like ROM, repeated movement. Neurological assessments - myotomes and dermatomes. Circulatory assessment- performing a hemodynamic assessment. References: Becquemont, L., Bauduceau, B., Benattarà ¢Ã¢â€š ¬Ã‚ Zibi, L., Berrut, G., Bertin, P., Bucher, S., ... Doucet, J. (2015). Association between Cardiovascular Drugs and Chronic Kidney Disease in Nonà ¢Ã¢â€š ¬Ã‚ Institutionalized Elderly Patients.Basic clinical pharmacology toxicology,117(2), 137-143. Conover, M. S., Hibbing, M. E., Hultgren, S. (2014). Introduction to Urinary Tract Infections.Metabolism of Human Diseases: Organ Physiology and Pathophysiology, 357. Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., ... Murray, C. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.Annals of the rheumatic diseases, annrheumdis-2013. Moyer, V. A. (2012). Screening for prostate cancer: US Preventive Services Task Force recommendation statement.Annals of internal medicine,157(2), 120-134. Tozzi, P., Bongiorno, D., Vitturini, C. (2012). Low back pain and kidney mobility: local osteopathic fascial manipulation decreases pain perception and improves renal mobility.Journal of Bodywork and Movement therapies,16(3), 381-391. Van Kampen, M., Geraerts, I. (2015). Evidence for pelvic floor physiotherapy in men. Walsh, N., Sarria, J. E. (2012). Management of chronic pain in a patient with autosomal dominant polycystic kidney disease by sequential celiac plexus blockade, radiofrequency ablation, and spinal cord stimulation.American Journal of Kidney Diseases,59(6), 858-861. Yale, J. F., Bakris, G., Cariou, B., Yue, D., Davidà ¢Ã¢â€š ¬Ã‚ Neto, E., Xi, L., ... Meininger, G. (2013). Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease.Diabetes, Obesity and Metabolism,15(5), 463-473.