A 60-year-old male was admitted to the hospital 5 days ago after a fall while playing tennis. Radiographs revealed two nondisplaced pelvic fractures on the right and magnetic resonance imaging (MRI) revealed internal derangement of his right knee as well as mild to moderate degenerative changes in the lumbar and sacral spine. Two days ago, his right knee was surgically repaired. There is mild swelling in the right lower limb and he reports mild to moderate pain in his surgical knee. He is medically cleared to begin walking with toe-touch weightbearing (TTWB) on the right lower extremity. He is limited by pain in the low back, perineum, left hip, and posterior left leg and sole of the foot. He can walk 20 ft with a front-wheeled walker with TTWB on the right. Walking is limited by pain and an inability to maintain left knee extension in stance. He was receiving fentanyl (intramuscular) until today when his pain medication was changed to oxycodone (oral) in preparation for discharge from the hospital. A review of his prior medical records reveals that the patient was seen in outpatient physical therapy 2 years ago for hip and low back pain (left side greater than right). At that time, he demonstrated muscle weakness in the hip extensors, plantar flexors, ankle evertors, and toe extensors. He improved over a 4-week course of physical therapy and upon re-evaluation 6 months later, his lower limb muscle strength had returned to normal (5/5 on Manual Muscle Test). Back then, his x-ray and MRI studies had already demonstrated mild to moderate degenerative changes in the lumbar spine. One month ago, he was seen in the emergency department for a sudden onset of severe low back pain that occurred when he was working out at the gym. He was discharged with pain medication and a recommendation for bedrest. He is to be discharged home in 2 to 4 days. He lives alone in a multilevel house. He is an investment broker who drives to work, where he has to walk approximately one block from the parking structure to his office. In recent years, he has played tennis at least two to three times each week. On the second postoperative day (POD 2), the physical therapist is asked to evaluate and treat this patient and make recommendations for further rehabilitation.
Based upon his health condition, what do you anticipate will be the contributors to activity limitations?
What are the examination priorities?
What precautions should be taken during the physical therapy evaluation?
What are the most appropriate physical therapy interventions at this time?
- CHRONIC PAIN: Pain that outlasts normal tissue healing time, is greater than would be expected from the extent of injury, and occurs in the absence of identifiable tissue damage1
- DERMATOME: Area of skin supplied by cutaneous ...