Fibromyalgia Case Study

Author/s

Becky Brinkworth, Lindsey Hudson, Morgan Jones, Remsing King, and Marley McGraw from the [[ http://www.physio-pedia.com/Pathophysiology_of_Complex_Patient_Problems%7CBellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.]]

Abstract

100 word limit, non-structured description

Patient Characteristics

Patient is referred to physical therapy after being involved in a motor vehicle accident (four months ago) and continuing to have ongoing pain and stiffness. Patient is 42 years old, female, Caucasian, and lives alone in her apartment. She was working as a receptionist at time of accident but is not currently able to work due to pain. Patient has a family history of rheumatoid arthritis and fibromyalgia. She has no history of significant alcohol or recreational drug use. Patient has had no past surgeries, no history of cancer. She is currently taking Prozac for her depression and anxiety. She was referred to physical therapy by her primary care physician. She has never been to physical therapy before today.

Examination

Subjective: Patient suffered from onset of back pain following MVA on November 15, 2014. After the accident the patient immediately complained of pain in her middle thorax and spine, her neck, and lower extremities. Patient also reports having difficulty sleeping and feeling fatigued and stiff in the mornings. Finally, patient has noticed problems with cognitive issues such as concentrating and the pain has impacted performing daily activities including cooking, cleaning, and working as a receptionist. She hopes to return to work and daily activities with less pain.
Patient reports seeing her primary care physician following the accident. The doctor recommended routine labs and had had x-rays done showing no fractures. The lab values (CBC, CMP, erythrocyte sedimentation rate) were all normal. Physician referred her physical therapy to help with her pain and fatigue.

Objective:
Body pain diagram: pain noted cervical spine, bilateral shoulders, low back, bilateral hips, bilateral knees
VAS: 8/10
Resting Vitals:

• Resting BP = 140/90
• HR = 88

Skin inspection: no abnormal rash or markings, skin temperature appeared normal
Reflexes: 2+ bilateral
Sensation: hypersensitivity noted in non-dermatomal patterns
MMT:

• Shoulder ABD bilateral= 4/5
• Shoulder Flexion bilateral= 4-/5
• Hip extension bilateral = 4-/5

PROM: WNL
AROM: decreased AROM noted in cervical spine, lumbar spine, and shoulders

• ROM deficits most likely due to self-limiting behavior caused by pain

Tenderness: trigger points noted over multiple points (12 of 18 predesignated sites)
Edema: noted in bilateral knees and wrists
Fibromyalgia Impact Questionnaire: 50
Fatigue Severity Scale: 40
ODI: 78%

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

Discussion

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

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