Case Presentation

Musculoskeletal module

AnjaliUcp a/L 207

Personal Information

• Name :apthul fathima• Age :49yrs• House wife• History of present complain: she had left side

back and buttoc pain for 3 months. Gradullay raised & radiating to left backleg upto foot.

• Some time numbness• Unable to stand for prolong time.

Observation

• Informal Observation - normal• Formal Observation -posture ;slight bending to

rightside; not equally give weight to limbs . Normal lumbar lordosis.

• gait notnormal,• ASIS,PSIS are lifted up in left side.

• NO Muscles atrophy • No Swelling around lower back• Skin texture normal.

palpation

• ASIS,PSIS,iliac crest ,ischial tuberosity, priformis muscle..there is a pain when palpating muscle.

muscle spasm ;PIRIFORMIS• No altered temperature& tenderness.

Examination

• AROM;• flexion : kf 92 with out kf 65• ,adduction:25• ,abduction:42• medial and lateral rotataion:40

• PROM• flex-110 with KF, with out kF-69• Add-32,abd -45• Medial rot-44,lateral rot-46

• Isometric resisted movements; same movements test isometrically.compare to non affected limb, muscle stregth less.<4>

Special test

• SLR:1ST did it for normal leg. then for affected leg. Raise leg until pt feel pain.<pain more in leg than back>. Then did SLR with neck flexed df posion> pain araised 50 to 70 flexion.

• conclusion: no disc herniation.Sciatic nerve compression.

• Piriformis test: positive

• conclusion: priformis syndrome.

PLAN OF TREATMENT

• The aim of interventions is to restore her movements & continue her normal activities of daily living with out difficulty.

• Objectives of interventions1.Relief pain,2.Increase ROM,3.Increase the muscle strength of thigh4.Reeducate functional movements of daily living.

• Tools of measurement:• Goniometer• Visual Analog Scale

TREATMENTSElectrotherapy 15mins IR: relaxing the mus +pain releive

• Exercise therapy:• 1.stretch piriformis,hams,glutei,iliop

• 2.soft tissue manipulation of lumbosacral &glutei• Transverse friction• 3. muscle strengthening

• Advices:• Avoid position which triggers pain,sleep on

non affected side.

discussion

She had left buttoc pain ,radiate to back of lower limb.so there is s neurological influence.it maybe disc herniation or piriformis syndrome<sciatic nerve>

Justification of interventions:

• Pain→ limit movements → joint stiff• Have to reduce pain in order to restore

movements• Have to ↑ROM because all the movements

are limited• Pain,joint stiff → limit movements → muscle

waste• So have to strengthen muscles

• Because of the pain she used to perform ADL by unaffected leg(left side), so have to re-educate activities