PT 858: Charcot-Marie-Tooth Disease Case Study: Difference between revisions
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[[File:Depiction of Pes Cavus.jpg|thumb]] | Specific Muscle Strength Testing: determined [[Tibialis Anterior|tibialis anterior]], [[Extensor Digitorum Longus|extensor digitorum longus]] and [[Extensor Hallucis Longus|extensor hallicus longus]] are primarily responsible for decreased strength of foot dorsiflexors and inverters[[File:Depiction of Pes Cavus.jpg|thumb|going to replace this with something sensation because this image will not move for me]] | ||
'''Neurological Assessment''' | '''Neurological Assessment''' | ||
Dermatomes: no deficits above the knee bilaterally. Below the knee does not follow a specific dermatomal pathway - altered sensation in L4-S1 below knee bilaterally. Patient presents with a stocking pattern. | |||
UMN: Babinski (-), Hoffman’s (-), Oppenheimer’s (-) | |||
LMN/Deep Tendon Reflexes: | |||
- '''C6''': Biceps/brachioradialis – 2 (normal) | |||
- '''C7''': Triceps – 2 (normal) | |||
- '''L3L4''': Patellar Tendon – 2 (normal) | |||
- '''S1S2''': Achilles Tendon – 1 (hyporeflexia) | |||
<u>Special Tests:</u> Upper Extremity - Spurlings (-), Distraction (-), Vertebral Artery (-); Lower Extremity - Slump (-), Straight Leg Raise (-) | |||
<u>Superficial Sensations</u> | <u>Superficial Sensations</u> | ||
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<u>Upper Motor Neuron Reflexes</u> | <u>Upper Motor Neuron Reflexes</u> | ||
'''Observational Gait Analysis''' | '''Observational Gait Analysis''' |
Revision as of 03:37, 10 May 2023
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Abstract[edit | edit source]
Introduction[edit | edit source]
Client Characteristics[edit | edit source]
The patient is a 25-year-old male who is completing his Master of Science in Chemistry at a Canadian university in Ontario. He was diagnosed with X-linked CMT type 1A by a neurologist at the at of 14. The patient has had an increased amount of ankle sprains in the past 6 months, with the most recent one being around 3 weeks ago, in addition to general pain on the dorsum of the foot, and self-referred to physiotherapy for treatment.
Examination Findings[edit | edit source]
Subjective[edit | edit source]
History of Present Illness
Past Medical History
Medications
Health Habits
Family History
Social History
Functional History
Current Functional Status
Objective[edit | edit source]
Observation
- Mild (R) mid-thoracic scoliosis
- UE muscle tone appears normal
- Bilateral pes cavus, more extreme arch of (R) foot, varus heel angle from posterior POV
- Bilateral hammer toes
- Distal mild muscle wasting of bilateral lower legs, stork inverted champagne bottle appearance notable on anterio-lateral leg
Range of Motion
Upper Extremity - All joints within normal limits for passive and active range
Lower Extremity - Hip extension: 14 degrees (R), 16 degrees (L); Ankle Dorsiflexion: 5 degrees (R), 6 degrees (L)
***all end feels normal
Manual Muscle Testing
Grade /5 (R) | Grade /5 (L) | |
Hip Extension | 4+ | 4+ |
Hip Flexion | 4 | 4 |
Knee Extension | 5 | 5 |
Knee Flexion | 4+ | 5 |
Ankle Dorsiflexion | 3 | 3+ |
Ankle Plantar Flexion | 4 | 4 |
Ankle Inversion | 3+ | 3+ |
Ankle Eversion | 5 | 5 |
Specific Muscle Strength Testing: determined tibialis anterior, extensor digitorum longus and extensor hallicus longus are primarily responsible for decreased strength of foot dorsiflexors and inverters
Neurological Assessment
Dermatomes: no deficits above the knee bilaterally. Below the knee does not follow a specific dermatomal pathway - altered sensation in L4-S1 below knee bilaterally. Patient presents with a stocking pattern.
UMN: Babinski (-), Hoffman’s (-), Oppenheimer’s (-)
LMN/Deep Tendon Reflexes:
- C6: Biceps/brachioradialis – 2 (normal)
- C7: Triceps – 2 (normal)
- L3L4: Patellar Tendon – 2 (normal)
- S1S2: Achilles Tendon – 1 (hyporeflexia)
Special Tests: Upper Extremity - Spurlings (-), Distraction (-), Vertebral Artery (-); Lower Extremity - Slump (-), Straight Leg Raise (-)
Superficial Sensations
Light touch
Pinprick
Deep Sensations
Proprioception
Vibration
Upper Motor Neuron Reflexes
Observational Gait Analysis
Outcome Measures