Orthopedic Physical Assessment and Physical Therapy

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In physical therapy, patients come to the clinic with a long list of symptoms and a specific mechanism of injury. It is the physical therapists job to take this information and form hypotheses of what pathology may be affecting the patient. With the patient that has been presented in this case, a full history shows a very good description of symptoms and what the patient remembers happening when the injury occurred. With this history, an examination plan can be created in order to make this examination process thorough, but efficient.
A hypothesis that can be made from the patient’s report is that she is suffering from cervical radiculopathy, or a nerve root lesion. Symptoms that describe cervical radiculopathy include: arm pain in a dermatome distribution, pain increased by extension, rotation, and/or side flexion, possible relief of pain from arm positioned overhead, affected sensation, altered hand function, no spasticity, and no change to gait or bowel and bladder function (Magee, 2008, p. 142). These symptoms correlate to what the patient reported as a result of her injury. She stated that her pain is in the posterolateral upper and lower arm with aching and paresthesia in the thumb and index finger, which is in the dermatome pattern of cervical root 5 and 6 (C5, C6) (Magee, 2008, p. 25). She also reports lancinating pain with extension or rotation to the right of her head.
There are several tests and measure that can be done in a physical therapy examination in order to rule out certain diagnoses, as well as come closer to a physical therapy diagnosis. First, an observation of the patient standing, walking, and sitting should be done in order to associate any visible deficits in the patient that could be associated to the ...

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... hypothesis and use tests and measures to confirm that hypothesis or bring them in a new direction to find a diagnosis. This patient reported symptoms that suggested cervical radiculopathy, and the special tests that were mentioned had the ability to indicate that this hypothesis is likely the case, or show that other pathologies must be considered.

Works Cited

Dutton, M. (2012). Dutton's Orthopaedic examination, evaluation, and intervention (3rd ed.). New York: McGraw-Hill Medical.
Magee, D. J. (2008). Orthopedic physical assessment (5th ed.). St. Louis, Mo: Saunders Elsevier.
Shabat, S., Leitner, Y., David, R., & Folman, Y. (2012). The correlation between Spurling test and imaging studies in detecting cervical radiculopathy. Journal Of Neuroimaging: Official Journal Of The American Society Of Neuroimaging, 22(4), 375-378. doi: 10.1111/j.1522-6569.2011.00644.x

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