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 extension on toe off, decreased speed, and Trendelenburg sign.
For postsurgical intervention without surgery, PT usually involved mostly with pelvic dysfunction and bladder control