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A 72-year-old Caucasian female was admitted to the hospital 4 days ago with complaints of severe back pain. The pain developed suddenly after lifting her 1-year-old granddaughter (21 lb) over her head. Radiographs show acute, moderate vertebral compression fracture at T7 and minor compression fractures at T6 and T8, which do not appear to be acute. Previous medical history includes hysterectomy with oophorectomy at age 43 years, left wrist fracture 20 years ago following a fall when she tripped on a broken sidewalk, right hip and lumbar pain due to osteoarthritis, and hyperlipidemia controlled with atorvastatin (20 mg daily). She had been managing pain in her back and hip with ibuprofen (400 mg taken on an as needed basis). She has never had an evaluation for osteoporosis or a bone density test by dual x-ray absorptiometry. After her discharge home from the hospital, she consults an endocrinologist for an osteoporosis evaluation. The physical therapist is asked to evaluate and treat the patient before discharge in 2 days, when she returns to her two-level home where she lives with her husband. The orthopaedic surgeon did not provide any precautions to movement and she is permitted to ambulate within pain tolerance. She currently reports a pain level of 7/10 on the numerical rating scale (NRS) in the region of T7. She also reports pain in her right hip when weightbearing (2/10). Upon admission, she was placed on morphine using a patient-controlled analgesia (PCA) pump. She experienced adverse drug reactions (ADRs) including lightheadedness, a feeling of being off-balance, nausea, and constipation. She requested to stop the “strong” pain medications in favor of other medications and non-pharmacological pain management. Prior to this incident, she was very active, participating in water aerobics twice weekly and playing doubles tennis once weekly.

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What are the examination priorities?

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What are the most appropriate physical therapy outcome measures for anthropometrics, posture, gait, and balance?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during the physical therapy examination and interventions?

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What are possible complications interfering with physical therapy?

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How would this individual's contextual factors influence or change your patient/client management?

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Based on her health condition, what do you anticipate will be the contributors to activity limitations?

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  • DUAL X-RAY ABSORPTIOMETRY (DXA): Imaging technique for measuring bone mineral density; gold standard and most commonly used technique for the diagnosis of osteoporosis
  • HYSTERECTOMY WITH OOPHERECTOMY: Surgical removal of the uterus and ovaries
  • OSTEOPOROSIS: Disease in which there is porous bone, low bone mass, and disruption of bone architecture and strength that leads to an increased risk of fractures
  • VERTEBRAL COMPRESSION FRACTURE: Broken bone in the spine; common site of fracture in individuals with osteoporosis; the fracture may ...

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