Crohn's Disease Case Study

Author/s

Patrick Allen, Ethan Brown, Jared Johnson, Kasie Lessley from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.

Patient Characteristics

• Demographic Information: (occupation/vocation, gender, age, etc.)
• Medical diagnosis if applicable
• Co-morbidities
• Previous care or treatment

Examination

• Subjective: Patient was referred to our clinic with instructions to assess and treat functional impairments secondary to spondylolisthesis. Pt presents to physical therapy with chief complaints of insidious onset low back pain which worsens with prolonged sitting or standing. Pain has been increasing over the past couple months with occasional radiation to the buttocks and thigh. Pt also complains of weakness and fatigue in both legs that presents when his back is painful. He reports difficulty sleeping uninterrupted due to lower back pain most nights, and is unable to sleep on his stomach. Pt is an avid recreational kayaker. Pt’s primary goal is return to kayaking without pain. Additionally, pt wants to improve strength in both legs and return to his normal exercise program without limitations from pain or lack of stability in his spine. Pt inquired about the possible effects of his Crohn’s Disease in correlation with his spinal fracture and impairments. Pt denies changes in bowel or bladder function since LBP onset.
• Self Report Outcome Measures:

 - Visual Analog Scale (VAS)
            ▪ Worst: 7
            ▪ Best: 2
            ▪ Current: 4

- Oswestry Disability Index (ODI): 25% - moderate disability

- Fear Avoidance Beliefs Questionnaire Physical Activity (FABQpa): 12

•  Objective
  - Posture: In standing patient displays increased thoracic kyphosis, forward head, protracted shoulders, increased lumbar lordosis as well as anterior pelvic tilt. 
  - Lumbar AROM:
  ▪ FB: 75% no pain, but has to use hands to assist return to neutral with significant juddering of paraspinals
  ▪ BB: 50% with sharp pain
  ▪ RSB: 50% with pain
  ▪ LSB: 50% with pain
  ▪ Rrot: 50% with pain
  ▪ Lrot: 50% with pain
•  Neuro Screen
  ▪ Sensation: decreased light touch sensation at lateral calf bilaterally
  ▪ Reflexes:
  ● L4: 2R, 2L
  ● L5: 1R, 1L
  ● S1: 2R, 2L
  ▪ Motor:
  ● Hip Flexion: 5/5 bilat
  ● Hip Abd: 4/5 bilat
  ● Hip Add: 5/5 bilat
  ● Knee Ext: 5/5 bilat
  ● Knee Flex: 5/5 bilat
  ● Ankle DF: 4/5 bilat
  ● Ankle PF: 5/5 bilat
  ● Gr Toe Ext: 4/5
• PIVM
  ▪ Hypomobility of mid thoracic-spine
  ▪ Hypomobility at L1/2, and L2/3
  ▪ Hypermobility at L4/5 (5/6)
• Hip ROM
  ▪ +Thomas Test bilateral
  ▪ Hip Extension: PROM 5 degrees Right, 10 degrees Left
  ▪ Hip ER PROM: 20 deg bilaterally
• Palpation
  ▪ Tenderness over L4/L5 vertebra with hyper-tonicity of paraspinals
  ▪ Step deformity noted at L5
  ▪ Pain in abdominal right lower quadrant with palpation
•  Special test:
  ▪ Active Straight Leg Raise (ASLR): R: 2, L: 1
  ▪ Prone Instability Test (PIT): positive
  ▪ Quadrant Test: positive bilaterally with extension
  ▪ Aberrant Movement Pattern During Active Trunk Flexion: Positive; with juddering and use of hands to return from 75% forward bending. 
• ICF Findings
  - Body Structures/ Function (Impairments)
  ▪ Decreased strength primarily in LE
  ▪ Decreased ROM in trunk
  ▪ Decreased postural control
  - Activity limitations
  ▪ Recreational Kayaking
  ▪ Unable to perform all ADL’s unrestricted/ pain free (shoe tying)
  ▪ Unable to engage in normal exercise routine without restrictions
  - Participation restrictions
  ▪ Has been unable to be recreationally involved with friends and social networks due to his activity limitations.
  ▪ Pt has pain when sitting at school for long periods of time
  ▪ Difficulty transferring patients due to back pain
  - Environmental Factors
  ▪ Pt has little family support at home currently (his apartment) as he has moved away from his hometown for school.
  

Summarization of Examination Findings

Working Diagnosis and Targeted Interventions

Intervention

• Phases of Interventions (e.g. protective phase, mobility phase, etc.)
• Dosage and Parameters
• Rationale for Progression
• Co-interventions if applicable (e.g. injection therapy, medications)

Outcomes

Findings Over time

Related Pages

http://www.physio-pedia.com/Crohn's_Disease

References

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