Breast Cancer Case Study

Author/s

Hannah Burke, Amber Burtch, Megan Stanitzek, Lauren Wilson, & Bridgett House students from Bellarmine University's Physical Therapy Program completing course requirements for PT 635 Differential Diagnosis of Complex Patient Problems.

Abstract

100 word limit, non-structured description

Patient Characteristics

• Female
• 58 years old
• Occupation: grade school teacher
• Direct access with complaint of shoulder pain
• Co morbidities: High blood pressure, Sedentary
• Past Medical Hx: Pt reports past rotator cuff repair,
• Family HX: High blood pressure, diabetes, mother passed away from breast cancer, hypothyroidism
• Previous Care or treatment: Patient had physical therapy 5 years ago following a right rotator cuff repair.

Examination

• Subjective : Pt reports insidious onset of right shoulder pain that began approximately 3 months ago. Pt reports pain is at worse 6/10, best 3/10. Pt describes the pain as a deep ache that wakes her up at night at least three times a week. Pt reports difficulty with self care activities such as bathing, hair care and dressing due to shoulder pain. Pt reports that she has lost weight unintentionally over the past month and attributes it to increased stress at work.
• Self Report Outcome Measures:QuickDASH - Score: 29.5%
  
• Objective :
  

Palpation: Tenderness noted on palpation along posterior aspect of GH joint.

ROM
     - PROM: WFL, c/o pain with end range abduction
     - AROM: R shoulder flexion- 110 (pt reported pain)
                    R shoulder abduction- 112 (pt reported pain)

MMT:

      R shoulder flexion: 4-/5
      R shoulder abduction: 4-/5
      R shoulder adduction: 4/5
      R shoulder extension: 4/5
      R shoulder IR: 4/5
      R shoulder ER: 4/5
      R Elbow Flexion: 5/5
      R Elbow Extension: 5/5
      Wrist Extension: 5/5
      Wrist Flexion: 5/5
      Supination: WFL
      Pronation: WFL
      Grip Strength: WFL
      Sensory: WFL
      Reflexes: WFL

Clinical Impression

Pt is a 58 year old female who presents to the clinic with complaints of right shoulder pain. Secondary to patients age, family history, and subjective report this patient was advised to return to their primary care provider for further medical screening. With this patient being a 58 year old female she is considered to be at risk for breast cancer. Another risk factor this pt possesses is a primary relative who has recently lost the battle to breast cancer. A significant concern with this pt is her complaints of night pain so severe it wakes her from sleep. This is a red flag that could indicate presence of tumor due to changes in hormone levels at nighttime that accompany neoplasms. The unexplained weight loss also gives reason to suspect a more systemic involvement rather than musculoskeletal origin.

Summarization of Examination Findings

Working Diagnosis and Targeted Interventions

Intervention

Patient followed-up with physical therapist with MD diagnosis of Stage 2 Breast Cancer. Due to patient’s family history of breast cancer, MD performed clinical breast examination followed by a mammogram. Tumor was found in R breast tissue but has not spread to lymph nodes or other surrounding organs. MD recommends continuing with surgical treatment to remove tumor through mastectomy. MD has written orders for post-op PT to manage wound care, swelling, and functional limitations. MD also requests multiple rounds of radiation (5 days a week for 5 weeks) (SGK) to ensure that abnormal cell growth has been ceased. Patient and caregiver were educated on possible side effects of radiation therapy including, skin irritation, redness, soreness, swelling, fatigue, Lymphedema. After being discharged from Acute PT, patient was advised to go to outpatient physical therapy and received Lymphedema treatment along with functional training. Upon discharge from OP PT, patient was instructed to continue with physical activity through exercise groups or community programs. Support group information was administered to patient as well.

Outcomes

Findings Over time

Discussion

Summary Statement which should include related findings in the literature, potential impact on clinical practices

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