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Student Hip 2015

Student hip

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73 views8 pages

Student Hip 2015

Student hip

Uploaded by

Anonymous JhEds4
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 8

PT

HEALTH CARE
PROBLEM

UNIT II
Musculoskeletal
Practice

MSc(PT)

Problem: Joshua Proski Then and Now


(NOTE: READ THE ENTIRE PROBLEM BEFORE GENERATING YOUR LEARNING ISSUES)

Joshua Then:
Joshua is an active 8-year old who has enjoyed playing soccer and many other
sports. Over the past month he is experiencing right hip and groin pain pain. He
also displays an antalgic gait. There was no history of an injury and he does not
have a fever.
What are possible causes of Joshuas problem and how would you distinguish
among these potential causes?

Joshua Now:
Relevant History Synopsis
Mr. Proski, a 43-year-old man, is scheduled to have an uncemented (femoral
stem component) right total hip replacement tomorrow. He has severe
osteoarthritis of the hip. He recalls having a hip problem when he was young
which limited his participation in sporting activities.
You are the physiotherapist on this ward.
You intend to assess Mr. Proski preoperatively. You introduce yourself and inform
him of your intent. He questions what is involved and asks whether he has a
choice.
What do you tell him?

Some Physical Examination Findings from your preoperative assessment


Body mass index (BMI) 30.2
Range of Motion
Flexion
Extension
Abduction
Adduction
Medial Rot.
Lateral Rot.
Strength
Flexors
Extensors
Abductors
Adductors
Medial Rot.
Lateral Rot.

Right

Left

85
5
22
14
0
28

118
12
34
24
22
34

Right*

Left

3
5
3
4
3
4

4
5
5
4
4
5

Gait: Patient demonstrates a Trendelenburg gait pattern


*Strength

grades are within passive range

Timed-up-and-go 14.1 seconds

6-minute walk distance 362 meters


Time to ascend and descend 9 stairs 27.9 seconds
Average walking speed over 40 meters (flat surface) 1.1 m/s



WOMAC Subscale Scores (see questionnaire on next page)


Pain
11/20
Stiffness
4/8
Physical Function 37/68
(Lower Extremity Functional Scale [LEFS] score 27/80)

1.

Using the PICOformat construct answerable questions


examining the meaning and validity of the measurements
listed above

2.

Conduct an efficient and effective literature search to


answer your questions

WOMAC: Please indicate your response with a check for the following questions.
Section A
During the past week, how much pain have you experienced in your hip or knee joints?
None
(0)
1.

Walking on flat ground

2.

Going up or down stairs

3.

At night while in bed

4.

Sitting or lying

5.

Standing upright

Mild
(1)

Moderate
(2)

Severe
(3)

Extreme
(4)

Section B
During the past week, how much joint stiffness (not pain) have you experienced in your
hip or knee joints? (Stiffness is a sensation or restriction or slowness in the ease with which you move
your joints)
None
1.
2.

How severe is your stiffness when you


first wake up?
How severe is your stiffness after
sitting, lying or resting later in the day?

WOMAC continued on next page

Mild

Moderate

Severe

Extreme

Section C
During the past week, what degree of difficulty have you experienced in your hip or knee
joint doing the following activities? (Difficulty is defined by your ability to move around and to look
after yourself)
None
1.

Going down stairs

2.

Going up stairs

3.

Getting up from a sitting position

4.

Standing

5.

Bending to the floor

6.

Walking on flat ground

7.

Getting in/out of a car

8.

Going shopping

9.

Putting on socks/stockings

10. Getting in/out of bed


11. Taking off socks/stockings
12. Lying in bed

Mild

Moderate

Severe

Extreme

13. Getting in/out of bathtub/shower


14. Sitting

15. Getting on/off toilet


16. Doing heavy household duties
17. Doing light household duties

LOWER EXTREMITY FUNCTIONAL SCALE


We are interested in knowing whether you are having any difficulty at all with the
activities listed below because of your lower limb problem for which you are currently
seeking attention. Please provide an answer for each activity.
Today, do you or would you have any difficulty at all with:
(Circle one number on each line)

ACTIVITIES

Extreme
Difficulty
or Unable
to Perform
Activity

Quite a bit
of
Difficulty

Moderate
Difficulty

A Little
bit of
Difficulty

No
Difficulty

a. Any of your usual work, housework or school


activities.

b. Your usual hobbies, recreational or sporting


activities.

c. Getting into or out of the bath.

d. Walking between rooms.

e. Putting on your shoes or socks.

f. Squatting.

g. Lifting an object, like a bag of groceries from the


floor.

h. Performing light activities around your home.

I. Performing heavy activities around your home.

j. Getting into or out of a car.

k. Walking 2 blocks.

l. Walking a mile.

m. Going up or down 10 stairs (about 1 flight of


stairs).

n. Standing for 1 hour.

o. Sitting for 1 hour.

p. Running on even ground.

q. Running on uneven ground.

r. Making sharp turns while running fast.

s. Hopping.

t. Rolling over in bed.

Column Totals:

16

Copyright JM Binkley (reprinted with permission)


(699)

Score: 27 / 80

Describe the typical rehabilitation program for a person post total hip arthroplasty.
(Time frame 1 day post-op to 3-months post-op). Be sure to consider
contraindications.
Day 1 Post-op
He is drowsy and reluctant to move. There is an incision covered by a
compression dressing on the lateral aspect of his right hip.
Sensory testing shows that he has normal sensation to light touch over the
medial aspect of the leg and foot.

Day 3 Post-op
You visit Joshua and he mentions that he is experiencing calf pain. You notice a
redness of the calf and that it is warm.

Day 5 Post-op
At Team Conference you are asked to determine whether a referral to Home
Care is appropriate, and if so, to prepare a note regarding Joshuas status for the
home care coordinator.
Joshua lives alone in a 2-level home. There is a bathroom on both floors.
Some Examination Findings
Range of Motion
Flexion
Abduction
Adduction

Right

Left

45
22
not tested

118
34
24

Right*

Strength
Flexors
Extensors
Abductors
Adductors
Knee ext
Knee flex.

Timed-up-and-go

not tested
not tested
not tested
not tested
not tested
not tested

Left
4
5
5
4
4
5

28.9 seconds

WOMAC Pain and Function Scores


Pain
8
Physical Function 37
(Lower Extremity Functional Scale [LEFS] score 20/80)

Joshua has booked a cruise in 12-weeks and asks if


this seems reasonable and what his physical function
is likely to be at that time.



Make a prognosis with respect to pain and functional


status. Consider both self-report and performance
measures and the information each conveys. Relate
these measures to the International Classification of
Functioning, Disability and Health (ICF) model.

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