183 Malignant neoplasm of ovary and other uterine adnexa1
183.0 Malignant neoplasm of ovary1
198.6 Secondary malignant neoplasm of ovary2
PREFERRED PRACTICE PATTERNS
A 55-year-old female presents with left LE pain 12 weeks s/p pelvic tumor debulking with end-block appendectomy, omentectomy, proctectomy, lower anterior resection of bowels with primary coloproctostomy and hyperthermic intraperitoneal chemotherapy, and G and J tube placement. Prior to her surgery she worked full-time as an interior decorator. She jogged and walked her dog on a regular basis for exercise. Since her surgery she has progressed from walking with a walker to a cane, and now does not need an assistive device for walking. She states that she walks slower than her normal pace and has a slight limp. Yesterday she was able to navigate a flight of stairs for the first time since her surgery (patient lives in a 2-level home). She has recently stopped wearing the knee brace because it was not allowing her to bend her knee. She received a few weeks of outpatient PT initially after her surgery. They did strengthening and balance exercises, endurance activities, electrical stimulation (for pain) and massage. She feels these helped somewhat; however, she has been newly diagnosed with left femoral nerve neurapraxia secondary to nerve compression during surgery. She is now recommended for neuromuscular re-education and would like to get back to her active lifestyle.
Past medical history (PMH) and past surgical history (PSH): Total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO), loop colostomy, rhinoplasty. The patient has visible atrophy of left (L) proximal LE musculature. Left hip MMT 3+/5 (extension 4/5), knee flexion and extension 5/5, and all ankle 5/5. Passive ROM of left LE all within normal limits (WNL). Active ROM hip flexion 95 degrees, extension (sidelying) 10 degrees, ABD 30 degrees, IR 45 degrees, ER 30 degrees. Patient notes minor pain with hip ABD and knee flexion. She is unable to perform supine active straight leg raise unassisted. Maintains single leg stance (SLS) for 30 seconds on right and left LE.
Thomas Test: Pain provoking, lacking approximately 20 degrees hip extension on left
Bilateral IT band tightness with tenderness to palpation only on left.
She reports current left LE pain to be 3/10, with increase to 6/10 with walking. She is currently taking pain medications on a regular basis and uses Lidoderm patches at night.
Sensation: Numbness in left anteromedial leg and WNL in foot. Distal reflexes WNL.
Gait deviations: Antalgic gait, decreased step length on left, lacking left terminal knee extension (TKE) on heel strike and left full hip ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.