Q67.5 Congenital deformity of spine
Q76.3 Congenital scoliosis due to congenital bony malformation
Q76.425 Congenital lordosis, thoracolumbar region
Q76.426 Congenital lordosis, lumbar region
Q76.427 Congenital lordosis, lumbosacral region
PREFERRED PRACTICE PATTERNS
4B: Impaired Posture1
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated With Localized Inflammation2
4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders3
A 38-year-old female was referred to physical therapy by her primary care physician. She presents with low back pain (LBP) that began in her seventh month of pregnancy. She reports that her baby is 3 months old, but the pain is still present. She notes that the pain is worse after standing for long periods of time at work as a middle school teacher. She notes that the pain is worse when she rotates her back to write on the board. She mentions that it is becoming difficult to carry her baby due to the pain.
The PT examination revealed the following information. Posture showed an increase in lumbar lordosis with an anterior pelvic tilt. Pain was reproduced during the lower quarter screening during lumbar extension. MMT revealed hamstring strength bilaterally 4-/5, with all other bilateral lower extremity (LE) muscles 5/5. PIVM showed mobility in the spine to be 5 at L2 to L4 and 4 at L5 to S1. Patient had a positive quadrant test to the right side, a positive prone instability test, and a positive Thomas test.
Excessive lumbar lordosis curvature
Increased extension of the lumbar spine compresses the facets
Anterior pelvic tilt
LBP with primary involvement of lumbar facet joint
Lower limb symptoms might be present in a nondermatomal pattern as a result of referred pain
Neurological findings, minimal
Lordotic posture, exaggerated by standing on toes, associated with trunk and hip weakness. (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012.)
Curvatures of the spine affecting the thorax. (A) Kyphotic thorax. (B) Lordotic thorax. (C) Scoliotic thorax. Note the narrowing of the rib interspaces on the right and the accentuation of the interspaces, posterior humping of the chest, and elevation of the shoulder on the left. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
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