Chronic or recurrent joint pain

Chapter 18 Chronic or recurrent joint pain

Case 18.1

History

While doing housework Sally, a 56-year-old woman, noticed discomfort in her right hand and right lower lumbar region. After completing the housework, she went to rest but noticed no improvement. Three days later she decided to consult a chiropractor. She described it as a continual dull pain, but with sharp exacerbations upon sudden movements. The visual analogue scale (VAS) is 6/10. Sudden movement is described as 8/10. The patient also complains of difficulty lifting teacups, cutlery and general items of everyday use. While not absolutely successful in subduing her symptoms, relieving factors included ice, lumbar support belts and wrist guards.

Over the past 8 years, she had undergone several periods of discomfort in both hands and lower back. The duration of each episode ranged from several days to weeks, with the pain usually resolving on its own. Over the years she had consulted several healthcare practitioners who diagnosed her with either stress-related problems or osteoarthritis. However, she had not undergone any X-ray examination or consulted a specialist about her condition. She did recall that during pregnancy she did not have any pain in her lower back or hands while carrying out normal housework.

Other complaints included mild frontal headaches occurring approximately once every 6 months. Episodes of ‘pins and needles’ which lasted 30–40 seconds occurred in her right hand. This was noted to occur approximately once every 4 weeks.

She perceives her general health as good. Surgical history included an appendectomy at the age of 16. Family history included a mother (now deceased) suffering from low back pain and bilateral foot pain diagnosed as osteoarthritis. Her father has type 2 diabetes mellitus. She has four children ranging from 20 to 13 years of age.

Physical examination

General	Sally presented as a woman of generally healthy appearance, although she appeared to be in some discomfort. She also had a noticeable disturbance in gait
Vitals	•Pulse rate/min	80 and regular
	•Respiratory rate/min	18 and shallow
	•Blood pressure mm Hg	128/82
	•Height (cm)	153
	•Weight (kg)	51
	•BMI	21.7
	•Temperature (degrees C)	36.9
HEENT	Unremarkable
Neck	Accessory muscle use was noted during breathing
Chest	Heart sounds normal; chest is clear; no cardiomegaly
Abdomen	Soft, non-tender, no distension or other abnormality
Limbs	• The dorsal aspect of the hands and fingers bilaterally were erythematous and warm. There was joint swelling at the metacarpophalangeal and wrist joints. Trophic changes were also noted over the same area. Flexion deformities were noted • General observation of the hands reveals noticeable muscle wasting, especially of interossei muscles • Wrist range of motion (ROM) was markedly decreased with pain. Slight ulnar deviation was noted. There was pain on movement
Structural analysis	Increased lumbar lordosis, decreased kyphosis, forward head carriage with right rhomboid and levator scapula muscle contraction. The right posterior superior iliac spine (PSIS) is observed and palpated more posterior and inferior compared to the left PSIS. There is right lumbar tilting to L1 with a short left thoracic translation
Back	Lumbar spine • All ROMs moderately decreased due to pain. Right side > Left side • Palpation of the lumbar area noted decreased mobility and temperature increase of skin over the area Cervical ROM • ROM decreased due to patient apprehension. Noted hypertonicity of anterior scalenes bilaterally
Neurological	• Upper limb: muscle power reduced in hand musculature, otherwise normal findings • Lower limb: normal findings, except S1 reflexes reduced bilaterally

Tags: Cases in Differential Diagnosis for the Physical and Manipulativ

Dec 26, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off

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