RT Book, Section
A1 Jobst, Erin E.
A1 Panus, Peter C.
A1 Kruidering-Hall, Marieke
SR Print(0)
ID 1192819662
T1 Drugs Affecting Eicosanoid Metabolism, Disease-Modifying Antirheumatic Drugs, and Drugs Used in Gout
T2 Pharmacology for the Physical Therapist, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259862229
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192819662
RD 2024/09/18
AB CASE  STUDYT.C.  is  a  54-year-old  postal  worker  with  a  long  history  of  bilateral  knee  pain  who  self-referred  to  outpatient  physical  therapy.  The  patient’s  current  medication  includes  daily  ezetimibe  (for  hyperlipidemia)  and  over-the-counter  acetaminophen  and  ibuprofen.  During  the  initial  patient  interview,  T.C.  tells  the  therapist  that  his  knee  pain  has  been  increasing  over  the  past  several  months  to  the  extent  that  he  is  concerned  he  will  not  be  able  to  make  it  to  his  goal  retirement  age  of  65  years.  As  T.C.  is  talking,  the  therapist  observes  bilateral  ulnar  deviation  of  T.C.’s  metacarpophalangeal  joints  and  Swan-neck  deformities  of  the  first  two  fingers.  When  the  therapist  notes  her  observation,  T.C.  adds  that  his  hands  are  also  stiff  and  painful,  especially  for  long  periods  in  the  morning,  and  that  he  has  had  progressive  difficulty  quickly  moving  envelopes  and  packages  in  and  out  of  his  carrier  bag.  Upon  closer  examination  of  T.C.’s  wrists,  the  therapist  observes  radial  deviation  with  swelling  that  feels  “boggy”  on  palpation.  Examination  of  T.C.’s  lower  extremities  reveals  mild  valgus  deformities,  no  edema,  and  no  loss  of  motion  around  the  knee.  The  only  positive  findings  are  decreased  strength  in  bilateral  hamstrings,  quadriceps,  and  hip  abductors.  The  physical  therapist  provides  T.C.  with  a  lower  extremity  strengthening  home  exercise  program.  She  asks  T.C.  to  follow  up  with  his  primary  care  physician  or  a  rheumatologist  for  further  evaluation.  T.C.  says  that  he  does  not  want  to  take  time  off  to  see  more  healthcare  providers  and  does  not  see  why  this  is  necessary.  T.C.  feels  that  these  new  leg  exercises  will  help  him  get  stronger,  and  that  he  may  just  try  to  “power  through”  the  pain  with  his  current  medication  regimen.