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Case studies (1).pdf Ayesha Malik

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Summary
 “Orthopedic Conditions

Case Study" by
Ayesha malik

INTERNSHIP PROJECT
1
Amity Institute of Physiotherapy

Amity University

Uttar Pradesh

In partial fulfillment

Of the requirements for the degree of

Bachelor of Physiotherapy

Under the guidance

ofDr. Jasobanta sethi

Amity Institute of physiotherapy

Amity University Uttar Pradesh

Noida
2022-23
Case study 1
DEMOGRAPHIC DATA NAME-
AGE – Prashant singh
GENDER- 35
DOMINANANT HAND-Right
COMPLAINT:
The patient reports that their right wrist hurts. He can't lift any weight.

Past Medical Background:

After the patient fell on their outstretched arm, a fracture was discovered. Wrist was immobilised for nine
days. Three days after the cast was taken off, he showed up in pain.

Medical history in general

• Personal history: the patient does not consume alcohol or smoke

• What proportion of routine work tasks can you complete? Thirty percent
• What proportion of tasks at home can you complete on your own? Answer: 60%

The history of the family

Absence of a relevant family background

The History of Pain:

• Abrupt onset of pain

• Pain location (body chart) • Pain intensity

• Pain Type: Diffuse Pain

• Painful behaviour
Rest: There is no pain while at rest.
Activity: Writing and lifting cause pain.

Mental Condition:

Consciousness level: Alert Vital Signs: Normal Blood Pressure

Normal temperature: 96 F; pulse rate:

Observation:

Constructed: Mesomorphic

Changing bodily postures: The patient can shift their posture with ease. Overall body alignment: aflicted
arm supported by a normal hand
Normal gait

Using an assistive technology: not

PALPATION:

There is pain in the wrist area. Present spasm

Present-day swelling

Skin temperature: somewhat warmer than average

Examining movements

Wrist flexion - insufficient and uncomfortable Wrist

Extension- a painful and incomplete motion Radial
Deviation- uncomfortable and insufficient Ulnar
Deviation- painful and insufficient

PASSIVE ACTIONS:

Wrist flexion: total and excruciating Wrist extension- complete and painful
Radial deviation- complete and painful

Ulnar deviation- complete and painful

The Functional Evaluation

Form a regular fist—impossible Possible hook grab

Possible pulp to pulp pinch

Thumb to tip to all fingers

A RADIOLOGICAL INQUIRY:

X-ray reveals a fracture at the lower end of the radius.

Diagnosis:

Colle's Fracture

PURPOSE OF TREATMENT:

Reducing discomfort, stiffness, improving range of motion, improving functional mobility, enhancing
muscular strength, and enabling the person to perform better in daily tasks are all goals.

Treatment:

Weeks 0–1: Hot water fermentation and range-of-motion exercises

Week 1: Turn on the key; Week 2: Pour a glass of water from the jug; Turn on the doorknobs.
Weeks two and three: increases in writing and grip strength

Week 3: strengthening with a minimum weight cuff and a steady increase in weight
Weeks 4 and 5: Weight-bearing Activities

Precautions:
If necessary, use wrist mobilizers; stay away from hard lifting
Steer clear of repetitious motions Consume a healthy, calcium-rich diet.
Case study 2
DEMOGRAPHIC DATA NAME-
AGE - KHYATI VERMA
GENDER- 42

DOMINANT HAND: The right hand

Chief Complaint:

Pain in both knees, with the right side experiencing greater discomfort than the left

Past Medical Background:

The last 2.5 years have been painful. Walking became very difficult as the pain steadily worsened. After
taking oral medication, the patient was later recommended for physical therapy. The patient is currently
being advised to get a total knee replacement and to undergo physical therapy for pre-operative
strengthening.

Medical history in general

• Personal history: the patient does not consume alcohol or smoke

• What proportion of routine work tasks can you complete? Answer: 40%
• What proportion of tasks at home can you complete on your own? Answer: 60%

The history of the family

Absence of a relevant family background

The History of Pain:

Pain Type: Diffused Pain; Gradual Onset of Pain

• Painful behaviour
Rest: There is no pain while at rest.
Activity: Walking and stair climbing cause pain.

Mental Condition:

Consciousness level: Alert Vital Signs: Normal Blood Pressure

Normal temperature: 97 F; pulse rate:

Observation:

Build: Endomorphic

Changing bodily postures: The patient can shift their posture with ease.

Body posture: Head positioned forward

Gait: Antalgic gait

Using an assistive technology: not

PALPATION:

surrounding the knee joint, there is pain. Present spasm

There is fascial tightness. Non-pitting edoema
Skin temperature: typical temperature

Examining movements

KNEE FLEXION: insufficient and uncomfortable

KNEE EXTENSION: insufficient and uncomfortable

UNIQUE TEST:

Knee bend that hurts a little at 30 degrees Painful to sit and stand
—difficult

REFLEX:

Knee jerk: typical

A RADIOLOGICAL INQUIRY:

Degenerative alterations in the knee joint are seen on an X-ray.

Diagnosis:

Knee osteoarthritis

PURPOSE OF TREATMENT:

• To lessen suffering

Reduce stiffness; enhance range of motion; boost muscular strength; enhance functional mobility; and
help the user perform better in regular activities.

Treatment:

Ultrasonic therapy frequency: 1 MHz, intensity: 2.5 W/cm³ for 5 minutes on both knees, IFT for 10
minutes. Week 0-Week 2.

WEEK 2: isometric exercise commencement; IFT for 10 minutes; and ultrasonic exercise for 5 minutes.
Weeks 3 and 4 include patellar mobilisation, isometric exercise, and ankle-to-toe motions.

WEEK 4-WEEK 5-isometric exercises, stretching of the calf, patellar exercise, and ankle-to-toe motions

Weeks five and six include isometric exercises, dynamic quadriceps, ankle-to-toe movement, patellar
exercise, calf stretching, knee traction with a belt, and heel slips.
WEEK 6-WEEK 7: isometric training, heel slips, calf stretching, ankle-to-toe mobility, patellar exercise,
dynamic quads, weight bearing exercise, and resistive knee flexion and extension

WEEK 8: Weight bearing exercises, dynamic quadriceps, isometric exercise, ankle-to-toe movement,
patellar exercise, calf stretching, heel slips, and resistive knee flexion and extension and gaittraining.
HOUSE PROTOCOL:

Prior to workout, hot water fermentation

Exercises for the isometric hamstring and quadriceps muscles mobility of the ankles and toes
Knee flexion and extension in bed Raise your legs straight
high flexion and extension of the seated knee

Note: You should complete each exercise ten times.

Treatment:

Avoid spending extended periods of time standing and sitting still

Wear knee braces or caps when walking.

Case study 3
DEMOGRAPHIC DATA NAME-
AGE - VIKAS GUPTA

GENDER- 38
DOMINANT HAND- Right hand
Chief Complaint:

Pain in both knees, with the right side experiencing greater discomfort than the left

Past Medical Background:

The last 2.5 years have been painful. Walking became very difficult as the pain steadily worsened. After
taking oral medication, the patient was later recommended for physical therapy. The patient is currently
being advised to get a total knee replacement and to undergo physical therapy for pre-operative
strengthening.

Medical history in general

• Personal history: the patient does not consume alcohol or smoke

• What proportion of routine work tasks can you complete? Answer: 40%
• What proportion of tasks at home can you complete on your own? Answer: 60%
The history of the family

Absence of a relevant family background

The History of Pain:

Pain Type: Diffused Pain
Gradual Onset of Pain

Painful behaviour

Rest: There is no pain while at rest.

Activity: Walking and stair climbing cause pain.

Mental Condition:

Consciousness level: Alert

Vital Signs: Normal Blood Pressure
Normal temperature: 97 F

Pulse rate: Normal

Temperature- 97 F

Observation:

Changing bodily postures: The patient can shift their posture with ease.
Using an assistive technology: not

PALPATION:

surrounding the knee joint, there is pain. Present spasm

There is fascial tightness.

Skin temperature: typical temperature

EXAMINATION-
KNEE FLEXION- incomplete and painful KNEE EXTENSION- incomplete and painful

UNIQUE TEST:

Knee bend that hurts a little at 30 degrees Painful to sit and stand
Leap—difficult

RESOLUTE:

Knee jerk: typical

A RADIOLOGICAL INQUIRY:

Degenerative alterations in the knee joint are seen on an X-ray.

Diagnosis:
Knee osteoarthritis

PURPOSE OF TREATMENT:

To lessen suffering
Reduce stiffness
enhance range of motion
boost muscular strength
enhance functional mobility
help the user perform better in regular activities.

TREATMENT-

WEEK 0-WEEK 2- ultrasonic therapy frequency-1Mhz intensity-2.5W/cm square for 5 minutes both knees,
IFT for 10 minutes.

WEEK 2-WEEK 3- isometric exercise initiation, IFT for 10 minutes and ultrasonic 5 mins.
WEEK 3- WEEK 4- isometric exercise, ankle toe movements and patellar mobilization.

WEEK 4-WEEK 5- isometric exercise, ankle toe movements, patellar exercise and calfstretching

WEEK 5-WEEK 6- isometric exercise, ankle toe movement, patellar exercise, dynamic quads, calf
stretching, knee traction using belt and heel slides
WEEK 6-WEEK 7- - isometric exercise, ankle toe movement, patellar exercise, dynamic quads, calf
stretching, heel slides, weight bearing exercise and resistive knee flexion and extension

WEEK 8- - isometric exercise, ankle toe movement, patellar exercise, dynamic quads, calf stretching, heel
slides, weight bearing exercise, resistive knee flexion and extension and gaittraining.

HOME PROTOCOL-

Hot water fermentation pre exercise

Isometric exercise of hamstring and quadriceps muscle Ankle toe movement
In bed knee flexion and extension Straight leg raise

High sitting knee flexion and extension

Note- all the exercise should be done 10 times.

PRECAUTIONS-

• Avoid using Indian toilets

• Avoid continuous sitting and standing positions for long hours.
• Use of knee caps or brace during walking
Case study 4
DEMOGRAPHIC DATA NAME-
AGE – saman khan
GENDER- 37
DOMINANT HAND- Right hand

Chief complaint:
Torment in lower back since most recent 2 months. not ready to sit and remain without help.

HISTORY:
/ History of present disease: Slowly expanded torment, trouble in standing and unfit to do any movement
with the two appendages
/ History of past disease and other medico-surgeries: None
Clinical History (HTN/DM) : psoriasis
/ Individual History (Smoking/Liquor/Other Maltreatment) : None
/ Has the patient ever to been to a physiotherapist: yes as of late .

Evaluation of Pain:

Both sides are affected (right, left, or both).

Pain intensity: 6 out of 10.
Location: Upper right part

/ Gradual/Sudden Onset: Gradually Duration: Each time you attempt to move your leg Factor aggravating:
Any movement of the lower limbs. Factor of Relief: Relax

Observation:

/ Limb attitude: Normal

Mesomorphic in nature; incapable of walking. Position: slightly lowered pelvis to the right Wasting
Muscle: Indeed
No deformity
None of the external appliances
Present Stiffness: Intact Sensation

ABOUT PALPATION:

Sensitivity: Right buttocks are present, and the right limb is warm.
Enlargement: On both rear areas
Lab Tests:
MRI - Disc bulging at L4,5 level .

Special Tests: SLR Test Positive

DIAGNOSIS
PIVD
MANAGEMENT AND TREATMENT

Short-term objectives: Acute and Subacute Phases

• lessen discomfort;
• release pressure from a compressed nerve;
• improve range of motion;
• prevent

Long-range objectives: Chronic Phase

• Pain relief;
• Maintain and restore;
• Range of motion;
• Muscle strength;
• Muscle endurance;
• Proper posture

MANAGEMENT FOR IMMEDIATE GOALS

Modalities

• IFT;
• Cold pack;
• Hot pack;
• Ultrasonic
Stretching

Hip flexion and extension;

knee to chest - single limb and both limbs;
hip mobility - capsular stretching;
calf stretching; iliopsoas stretching;
patella mobilization;
neural tension - progressively increase;
hold relax technique

MEDICATION FOR LONG-TERM GOALS EXTENDING

SLR hamstring stretching above 90 degrees with dorsiflexion;

Stretching the calves
Hip mobility;
prone-kneading;
IT band stretching; quadriceps stretching;
iliopsoas stretching;
patella mobilization;
cat and camel stretching

IMPROVED

• Bridging;
• Knee to chest;
• Spinal extension
• Strengthening of lower limb muscles with weight cuffs.
• Uplifts
• Climbing stairs
• Using a theraband to strengthen your dorsiflexion

WALKING:
Sidewalking;
Walking in Pairs

Postural Correction

• Pelvic stabilisation exercises;

• Strengthening exercises for weak muscles;
• Closed-chain lower limb exercises using an ergometer cycle

HARMONY EXERCISE

• Walking on a straight line;

• One-leg stand;
• Cross-walking;
• Wobble board

HOME MANAGEMENT

The use of cryotherapy reduces inflammation and Diminish edoema.

Twice daily, apply for ten to fifteen minutes.

Take a break;

Refrain from bearing too much weight;

Refrain from lifting anything;

Avoid bending forward

Case study 5
DEMOGRAPHIC DATA NAME-
AGE – Mahek Chaudhary
GENDER- 40
DOMINANT HAND- Right hand
Chief complaints:
The patient appearances trouble in walking. She is likewise feeling pain in the two knees.
Past clinical history - Nothing
General clinical history;
Individual history
Family-nothing
Occupational-nothing
Psychological-nothing
Pain history
1. Onset of torment steady
2. Location of torment average joint lines reciprocal knee
3. Intensity of torment 4/10
Conduct of side effects increment with strolling.
1. Aggravating variable Strolling, delayed standing
2. Relieving element - Rest

OBJECTIVE Evaluation
Mental status;
• Level of cognizance alert
• Respiratory rate (12-20 breaths/min)- 14 inhale/min
• Circulatory strain( 120/80 mmHg)- 125/80mmHg
• Beat rate(60-100 beats/min)- 73beats/min
• Body temperature(97-99F)- 97F

OBSERVATION
General stance Stacking favoring the sidelong line Capacity to perform-Free Changing
position and moves - Autonomous
Assembled Endomorphic Variety and surface of skin-
1. Cyanosis-not present
2. Erythema-not present
3. Scars/wound - not present

Palpation
Delicate tissue structure-
1. Swelling-present around the left knee
2. Tenderness-present over the average joint line of the knee
3. Nodules-not present

4. Trigger focuses not present\

5. Tightness-back case, Vastus lateralis, TFL
6. Wasting - not present

Assessment
Muscle tone - Typical Scope of movement; ROM
• Knee flexion 110-5
• Knee extension5-110
• Hip flexion 107
• Hip expansion 20
• Hip kidnapping 43
• Hip adduction 20

Manual muscle testing; Muscle bunch Grade

2
• Hip flexors 3/5
• Hip extensors 3/5
• Hip abductors 3+/5
• Knee extensors3-/5
• Knee flexors 3/5

Step - Antalgic walk

Appendage length error not present Differential finding;

• Upper leg tendon/PCL insecurity
• Menisci tear
• Patellofemoral torment Exceptional test;
• McMurray test-negative
• Lachman's test-negative
• Clarks' sign-positive

Analysis - Osteoarthritis of respective knees.

Treatment objectives;
Momentary objectives
• To assuage torment.
• To further develop muscle strength.
• To start balance preparing.

Long haul objectives

• To proceed with equilibrium and proprioception preparing.

• To further develop stride
• To reinforce the knees

Treatment Plan;
• Ultrasonic for 5 minutes recurrence 1.5Mhz
• Tens for 15 minutes
• Cold Pack for 10 minutes to die down enlarging
• Mix treatment around knee joint B/L.
• Extending exercise for hamstrings, IT band, piriformis, quadriceps, TFL, back case for 30
seconds hold with 3 reiterations.
• Isometric activities with a towel.
• Reinforcing activity of glutes, VMO, quadriceps for 10-second hold with 10repetitions.
• Knee fortifying activity with yellow theraband and theraloop.
• Weight sleeve at first beginning with 0.5 kg then to 1.5kg (SLR)
• Balance board Safeguard and Home Exhortation
• Try not to stroll on a lopsided surface.

• Keep feet raised while sitting or lying

• Keep away from delayed standing.
• Stay away from cross siting.
 Similarity Report ID: oid:16158:54377898

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