Hodgkin's Lymphoma Case Study

Author/s

A.J. Costin, Callie Eaves, Dan Purdy, and Lauren Willis from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.

Abstract

100 word limit, non-structured description

Patient Characteristics

• Demographic Information: Mr. Hodgkin's is a 61 year old caucasian male. He has worked as an electrical engineer for 30 years.   
• Medical diagnosis: Referred from primary care physician to therapy for low back pain (LBP) due to history of disc herniation. No recent imaging. MRI from 5 years ago. 
• Co-morbidities: HTN, BMI = 27, hyperlipidemia
• Previous Physical Therapy: Mr. Hodgkin's has received prior physical therapy for disc herniation at L4-L5 five years ago.

Examination

Subjective:  

Mr. Hodgkins reports a four month history of pain in his low back and recently the pain has moved into his left hip. He states this pain is different from his previous low back pain; it is lower and this is the first time that he has experienced hip pain. His chief complain is that when he comes home from work he is just too tired to go fishing or work in his wood shop. He states his doctor instructed him on dieting and exercise to lose weight and decrease HTN and cholesterol, but he states he just hasn't had the energy to exercise or perform his usual hobbies. However, he has lost some weight even though he's not sure how much. Pt reports the pain wakes him up at night and can't seem to get comfortable and sitting for long periods of time at work bothers him. He says he recently started doing some of the stretches and light exercises that were given to him by his last therapist; they helped a little at first but doesn't seem to be making much of a difference. 

• Patient's Past Medical History:  Patient reports HTN and high cholesteral both managed medically.  He  Patient was hospitalized 10 years ago for infectious mononucelosis, and he reports his mother passing away from breast CA 10 years ago. Patient reports no other significant past medical history (liver, lungs, DM, kidneys), and he does not smoke and rarely drinks alcohol socially because he notices that drinking makes his pain worse. 
• Medications:  Prinivil, Crestor, and Aleve (prn)
• Patient Goals: His primary goal is to decrease his pain and increase his stamina so that he can return to fishing and working in his woodshop. 
• Self Report Outcome Measures: Numeric Pain Rating is 4 at best and 5 at worst and the pain is constant; Oswestry Disability Index (46%)
• Physical Performance Measure: 2 minute walk test, RPE: 16 (distance 125 meters; cardiovascular response WNL, decreased distance likely due to fatigue and need for rest breaks)
  

Objective :

• ROM: Lumbar ROM decrease 75% of normal, no increase in pain with movement; Hip ROM 75% of normal, no increase in pain with movement. All other ROM measurements within functional limits, no pain. 
• Reflexes: +2 for L3/4, L5, and S1
• Sensation: Normal
• MMT: 4+/5 on LE general exam
• Palpation: Hip pain not reproduced with palpation, pain over center of sacrum present with palpation, positive costell's percussion
• Special Tests: + Slump Test, SLR negative bilaterally, FABER decrease motion, pain negative bilaterally

Clinical Impressions

Mr. Hodgkin's presents to physical therapy with LBP and left hip pain. He has a history of LBP and has responded well to prior physical therapy. The symptoms that he presents with now are inconsistent with her former symptoms and inconsistent with pain of musculoskeletal causes. The following symptoms warrant the need for further systemic screening by his primary care physician: pain is constant and not reproduced with movement, fatigue present with low intensity activity, general malaise, history of cancer in primary family member, history of infectious mononucleosis, non-intended weight loss, and positive lumbar percussion test. 

Summarization of Examination Findings

1. Cancer - Metastasis to the Lumbar/Sacral Area

2. Lumbar radiculopathy referring pain to hip area

3. Reoccurence of Epstein Barr Virus/mononucleosis

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

Related Pages

Hodgkin's Lymphoma - Physiopedia

References

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