PHYSICAL THERAPY EXAMINATIONʼS KEY ROLE IN ESTABLISHING MEDICAL DIAGNOSIS IN A PATIENT WITH LOWER EXTREMITY PAIN RELATED TO WALKING.

Abstract

Background & Purpose: The purpose of this presentation is to show how a thorough, focused PT examination reveals clinical information that can improve medical treatment of undiagnosed conditions. Physical therapists are required to critically assess each client presentation to determine the best course: physical therapy treatment, physical therapy treatment and contact primary care physician, refer directly to physician services prior to physical therapy services, or no physical therapy services needed at this time. This specific client case clearly illustrates the foundation principles of physical therapy examination/evaluation, and resultant positive client outcome. This assessment occurred in a specialty-teaching clinic, which facilitates the focus and time for critical physical therapy diagnosis. Case Description: This case reflects the physical therapy examination and treatment of a 72 year old client referred with a diagnosis of polyneuropathy of the lower extremities and history of stroke. The physical therapy evaluation noted diminished pedal pulses unilaterally, a slow healing wound on her right 5th toe, pain reported with weight bearing on right lower extremity, and timed activities that recreated the pain syndrome. These combined with a collection of symptoms (occurring for 3+ years) and consultation with the patient's physician led to further testing and a diagnosis of arterial insufficiency with a resulting positive surgical intervention. Outcomes: The client was able to advance her mobility status minimally, mainly balance improvement, during skilled PT prior to the surgical intervention. After the surgical procedure the client participated in limited physical therapy visits and resumed walking functional distances without pain. She reports ‘I have my life back again.’ Prior to the diagnosis and intervention, the client was able to participate in limited household activities. She was unable to participate in events requiring greater than one to two minutes of weightbearing such as family picnics, walking in the park, grocery shopping, and other activities. She has since resumed most of these activities without pain. Discussion: Physical therapists play a key role in establishing a medical diagnosis in cases where the symptoms revolve around functional activities that may not be fully revealed in a typical physician visit. Finely honed examination and evaluation skills are essential, the focused time to execute these skills, and the ability to communicate the assessment data in a collegial manner to the client's healthcare team are all critical to the physical therapist's role in improving client functional outcomes.