Physical Therapy Pathophysiology

Question: 1. Are the five elements of patient management integrated into the case study? The five elements are: Examination, Evaluation, Diagnosis, Prognosis, and Interventions. Explain your answer. 2. Give an example of how each were demonstrated or not, within the information presented in the case study. 3. Compare and contrast somatic and visceral pain. 4. What type or types of pain are identified in this study? (2pts) 5. Define referred pain. What was the source of pain in this case? Why did the pain manifest itself in the testicle region? 6. How can the information presented in the case report be of value to you as a physical therapist practicing in a direct access setting? Answer: Yes, the five elements of patient management that are examination, evaluation, diagnosis, prognosis and interventions are integrated into the given case study. Prior to his PT examination, he was referred to an orthopaedic surgeon and after suitable examination; he is referred to PT for conservative management. During the period of PT evaluation different kinds of other complications were found based on which suitable diagnosis, prognosis, and interventions were carried out. One month prior to the PT examination, he was noted with a sharp right upper buttock pain followed by 1) right testicular pain and 2) posterior leg paresthesias. It was noted that his symptoms worsened, and he was further provided treatment by using non-steroidal inflammatory medicines and was then given reference for an orthopedic surgeon for the low back and buttock symptoms. With various kinds of medical diagnosis, he was further referred to PT for conservative management because of his continuing back and right lower extremity symptoms. During the time of evaluation associated with the PT, the patient was not being able to seat properly and was also not being able to run. He was also facing intense pain and the testicular symptoms with a provocation of active, sharp movements into extension. After suitable determination, the patient was given appropriate conservative management, which falls under the diagnosis portion. During the diagnosis period, he was treated 12 times by physi cal therapist for three months with the main objective for minimizing the limits on the spinal cord and hip flexibility. During the fourth visit, it specifically involved thoracolumbar junction and stretching of hip, which in turn reduced the buttock pain and the testicular pain of the patient. Mobilization included grade IV central and right unilateral that dealt with movements of the T-10 to L2 vertebrae along the anterior-posterior direction with adequate repetitions. The diagnosis also included stretching of the psoas muscle by holding the patient in the horizontal position that provided pelvic stability. During the remaining eight visits, the treatment involved identifying the restrictions and the primary focus was on addressing the succeeding trunk and the lower margin strength. Using a suitable Stabilizer pressure device, reduction of the neuromascular pain for the lower abdominal muscles was also implemented. The program of trunk reduction included exercises for strengthenin g the physical activities of the patient. When improvement was seen in the pelvic position, strengthening of the trunk musculature that included the neutral spine position was also introduced that emphasized further strengthening. Thus, various kinds of balanced movements were performed by applying a medium density foam mat. Somatic pain refers to the pain of the musculoskeletal system (Labus et al., 2016). Since, most of the nerve is associated with the supply of impulse to different kind of muscles, bones and other related tissues of the body it is much easier to locate the somatic pain than the visceral pain. The degree of somatic pain is also intense. The physical pain condition that arises because of the somatic pain specifically includes chronic back pain, pelvic pain, pelvic joint instability (Wegner et al., 2013). Somatic pains can be either deep or superficial that particularly arises from various kinds of nociceptive receptors that remain present in the skin, membranes and different joints of the body. Visceral pain refers to the internal pain. It particularly refers to the pain that comes from blood vessels and the various organs associated with the body (Wegner et al., 2013). Visceral pain makes the body feel dull, vague and may be harder to pinpoint (Cervaro, 2016). The common types of visceral pain include prostate pain, bladder pain. It specifically refers to generalized squeezing that is particularly caused by compression in and around the organs. The types of pain identified in this study are: Sharp Right Upper Buttock Pain Aching Right Testicular Pain Low Back Pain Referred pain relates to the pain that is perceived at the other location rather than the site where the painful stimulus is produced. The pain specifically resulted as a result of lower back injuries as well as the injuries caused by the muscle and the problems that are caused around the pelvis. The pain also rose because of the bulletproof jacket that he used to wear and the pain manifested itself in the testicular region as most of the pain was related to his lower region and as a result, the pain accumulated in the testicular region The information will help me to understand the problems that remain associated with the patient suffering from ventricular pain. It also includes better management of the patients by understanding the condition of the patient that the person is going through and as a PT; it will help me in dealing with more precise and effective way with patients who has been diagnosed with various kinds back pain. Differential Diagnosis for Physical Therapists (Chapter-1) The three factors that create a need for screening are: Medical Specialization With the increase in the specialization of medicine, the client remains associated with the evaluation by a medical consultant who is not being able to identify the cause of the disease or the authority may also assume that giving reference to the key care physician has also been associated with ruling the other causes. Progression of time and disease In particular, cases of screening, diagnosis of early signs and symptoms of systematic disease becomes challenging and as a result, it becomes difficult to identify until the disease has progressed enough by creating distressing or noticeable symptoms. In certain cases, the patient and the clients scientific presentation in the physician office may also become different, from which the analyst observes when the days separate the two appointments. Thus, for proper screening, it is important to give time and understand regarding the process of the disease that will help them in the better understanding of the symptoms. Patient/ Client Disclosure The patient client disclosure is another important factor that helps the therapist to know about the status of the health based on the social history that will help them in providing the current screening technique. The content of the suitable conversations thereby holds a vital screening clue from pointing out the systematic illness or the cause of the musculoskeletal or neuromuscular impairment. Answer to question-2 Nowadays it is becoming difficult for the physical therapists to screen patients in today's world because of the fact that now a day's PT runs in a shortage of time and, as a result, they skip in knowing the client history. As a result, correct diagnosis by the PT is not made because the diagnosis is not done, and thus, information is not extracted properly that will help them in the better understanding of the patient's position on the kind of disease from which the client is suffering. The concrete and the structured tools are not taken into consideration these days because the physical therapists are not getting proper education that helps them to the better understanding of the patient's condition. In recent days, the types of data that are generated from a client history are not also interpreted and as a result proper information about the social history and the other related factors are not taken as a suitable outcome. Answer to question-3 The System Review is defined as the concise or the incomplete examination dealing with anatomic and the physiological status of the cardiovascular/pulmonary, musculoskeletal and neuromuscular systems. The System review has also taken into consideration the evaluation of the clients statement that focused on ability, cognition, learning and language style. The System Review also helps in looking beyond the key problem that forced the customer to bring to the therapist in the first instant. The System Review also helps the therapists to answer the question properly. The Review of Systems on the other hand forms a part of the screening process that serves as an important tool in recognizing the clusters of signs and symptoms that remains associated with it. It is thus used as an effective tool that helps the therapists to look back and take into consideration of all the presenting factors that suggests that the clients problems is beyond the understanding of the physical therapists practice. References Cervero, F. (2014). Pathophysiology of visceral pain.Revista Dor,15(2), 133-138. Goodman, C. C., Snyder, T. K. (2013).Differential diagnosis for physical therapists. Elsevier Health Sciences. Labus, J. S., Naliboff, B., Kilpatrick, L., Liu, C., Ashe-McNalley, C., dos Santos, I. R., ... Tillisch, K. (2016). Pain and Interoception Imaging Network (PAIN): A multimodal, multisite, brain-imaging repository for chronic somatic and visceral pain disorders.Neuroimage,124, 1232-1237. Wegner, A., Elsenbruch, S., Maluck, J., Schedlowski, M., Benson, S. (2013). 150. Somatic pain sensitivity during experimentally-induced inflammation in humans.Brain, Behavior, and Immunity,32, e43-e44.