Scleroderma Case Study: Difference between revisions
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<![endif]--> <!--StartFragment--> <u><span style="font-family: 'Times New Roman';">Subjective</span></u> | <![endif]--> <!--StartFragment--> <u><span style="font-family: 'Times New Roman';">Subjective</span></u> | ||
<span style="font-family: 'Times New Roman';">Mrs. Smith comes into the clinic complaining of joint pain and | <span style="font-family: 'Times New Roman';">Mrs. Smith comes into the clinic complaining of joint pain and | ||
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therapy are to decrease her joint pain and to get her muscles stronger so she | therapy are to decrease her joint pain and to get her muscles stronger so she | ||
doesn’t struggle at work any longer. Her focus is on getting her hands and arms | doesn’t struggle at work any longer. Her focus is on getting her hands and arms | ||
“back to normal” because they are what she uses most in her job.</span> | “back to normal” because they are what she uses most in her job.</span> | ||
<span style="font-family: 'Times New Roman';"> </span> | <span style="font-family: 'Times New Roman';"> </span> | ||
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<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Health | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Health | ||
Assessment Questionnaire Disability Index (HAQ-DI)<sup>4</sup>: 1.1 | Assessment Questionnaire Disability Index (HAQ-DI)<sup>4</sup>: 1.1</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Disabilities | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Disabilities | ||
of Arm, Shoulder, and Hand Questionnaire (DASH)<sup>5</sup>: 34 | of Arm, Shoulder, and Hand Questionnaire (DASH)<sup>5</sup>: 34</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Verbal | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Verbal | ||
Pain Intensity Scale: “Severe pain” | Pain Intensity Scale: “Severe pain”</span> | ||
<span style="font-family: 'Times New Roman';"> </span> | <span style="font-family: 'Times New Roman';"> </span> | ||
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<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Grip | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Grip | ||
strength (R)<sup>6</sup>: 20.7 kg | strength (R)<sup>6</sup>: 20.7 kg</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Grip | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Grip | ||
strength (L)<sup>6</sup>: 19.18 kg | strength (L)<sup>6</sup>: 19.18 kg</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Pinch | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Pinch | ||
strength (R)<sup>6</sup>: 4.27 kg | strength (R)<sup>6</sup>: 4.27 kg</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Pinch | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Pinch | ||
strength (L)<sup>6</sup>: 3.98 kg | strength (L)<sup>6</sup>: 3.98 kg</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Oral | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Oral | ||
aperture<sup>7</sup>: 28 mm | aperture<sup>7</sup>: 28 mm</span> | ||
<span style="font-family: 'Times New Roman';"> </span> | <span style="font-family: 'Times New Roman';"> </span> | ||
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<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">MMT: | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">MMT: | ||
WNL except for the following | WNL except for the following</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">4/5- finger and thumb abduction, | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">4/5- finger and thumb abduction, | ||
adduction, flex, ext | adduction, flex, ext</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">4/5- wrist flex and ext | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">4/5- wrist flex and ext</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">3+/5- shoulder flex and abduction | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">3+/5- shoulder flex and abduction</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">3+/5- hip flex and abduction | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">3+/5- hip flex and abduction</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">ROM: | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">ROM: | ||
WNL except for the following | WNL except for the following</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">decreased flexion and extension in | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">decreased flexion and extension in | ||
all finger MCP and IP joints | all finger MCP and IP joints</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">decreased wrist flexion and | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">decreased wrist flexion and | ||
extension | extension</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">decreased hip extension and | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">decreased hip extension and | ||
abduction | abduction</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Reflexes: | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Reflexes: | ||
WNL | WNL</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Sensation: | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Sensation:</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Decreased facial sensation | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Decreased facial sensation</span> | ||
<span style="font-family: 'Times New Roman';"> </span> | <span style="font-family: 'Times New Roman';"> </span> | ||
<u><span style="font-family: 'Times New Roman';">ICF Findings | <u><span style="font-family: 'Times New Roman';">ICF Findings</span></u> | ||
<!--[if !supportLists]--><sup><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><sup><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span></sup><!--[endif]--><span style="font-family: 'Times New Roman';">Impairments<sup>1,2,8 | </span></span></sup><!--[endif]--><span style="font-family: 'Times New Roman';">Impairments<sup>1,2,8</sup></span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is has stiffening around | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is has stiffening around | ||
fingers and what appears to be finger flexion contractures developing | fingers and what appears to be finger flexion contractures developing</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient has noticeable hard deposits | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient has noticeable hard deposits | ||
palpated around UE joints | palpated around UE joints</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient has slurred speech due to | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient has slurred speech due to | ||
difficulty fully opening mouth. The skin around the face is thickened and has | difficulty fully opening mouth. The skin around the face is thickened and has | ||
begun to cause puckering. | begun to cause puckering.</span> | ||
< | <span style="font-family: 'Times New Roman';" /><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span | </span></span><span style="font-family: 'Times New Roman';">Patient has dyspnea and chest pain | ||
upon exertion. | upon exertion.</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Activity | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Activity | ||
limitations<sup>1,2,8</sup> | limitations<sup>1,2,8</sup></span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is unable to complete | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is unable to complete | ||
activities in supine secondary to reflux symptoms | activities in supine secondary to reflux symptoms</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is unable to complete | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is unable to complete | ||
overhead activities due to decreased shoulder ROM. | overhead activities due to decreased shoulder ROM.</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is unable to complete more | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is unable to complete more | ||
than 30 minutes of repetitive movements due to fatigue, muscle weakness, and | than 30 minutes of repetitive movements due to fatigue, muscle weakness, and | ||
joint pain. | joint pain.</span> | ||
<!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Environmental | <!--[if !supportLists]--><span style="font-family: Symbol;">·<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Environmental | ||
factors<sup>8</sup> | factors<sup>8</sup></span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | ||
</span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is employed as a packer at a | </span></span><!--[endif]--><span style="font-family: 'Times New Roman';">Patient is employed as a packer at a | ||
plastics company. | plastics company.</span> | ||
<!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> | <!--[if !supportLists]--><span style="font-family: 'Courier New';">o<span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> |
Revision as of 04:42, 27 March 2015
Author/s[edit | edit source]
Catelin Infante, Jessica Frederick, Kristin Casagrand, Jarrod Smith from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.
Abstract[edit | edit source]
100 word limit, non-structured description
Patient Characteristics[edit | edit source]
- Demographic Information: (occupation/vocation, gender, age, etc.)
Native American
Female
Born and raised in Oklahoma
Works in a factory
Thirty-five years old
Family history of rheumatoid arthritis on mother's side
- Medical diagnosis if applicable
Scleroderma
- Co-morbidities
Hypertension, Type II Diabetes
- Previous care or treatment
Previous physical therapy for low back pain
Examination[edit | edit source]
Subjective
Mrs. Smith comes into the clinic complaining of joint pain and muscle weakness, especially in her hands, hips and shoulders1. She explains that she has been having trouble making it through a full day of work because her body feels limited and she just cannot reach as well for boxes at her job because “her arms won’t go up that far.” She also has noticed that she gets out of breath and sometimes has chest pain when she lifts a lot too quickly2. Mrs. Smith indicates that her fingers often feel very swollen and stiff and sometimes feel “stuck” in a bent position1. She reports that for several months she has been getting a really cold, numb feeling in her fingers throughout the day, especially when she is sitting in the air conditioning at her office3. Overall, she has just not felt well for the past few months either. When she eats, she has trouble fully opening her mouth to put food in2. Then, when she lies down at night after dinner, she gets a feeling of heartburn and sometimes feels like she has to vomit1. However, she says she has been eating poorly lately, so it’s probably her fault she hasn’t felt well. Additionally, Mrs. Smith reports losing 20 pounds in the past month without any lifestyle changes. Her goals for therapy are to decrease her joint pain and to get her muscles stronger so she doesn’t struggle at work any longer. Her focus is on getting her hands and arms “back to normal” because they are what she uses most in her job.
Self Report Outcome Measures<o:p></o:p>
· Health Assessment Questionnaire Disability Index (HAQ-DI)4: 1.1
· Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH)5: 34
· Verbal Pain Intensity Scale: “Severe pain”
Physical Performance Measures<o:p></o:p>
· Grip strength (R)6: 20.7 kg
· Grip strength (L)6: 19.18 kg
· Pinch strength (R)6: 4.27 kg
· Pinch strength (L)6: 3.98 kg
· Oral aperture7: 28 mm
Objective <o:p></o:p>
· MMT: WNL except for the following
o 4/5- finger and thumb abduction, adduction, flex, ext
o 4/5- wrist flex and ext
o 3+/5- shoulder flex and abduction
o 3+/5- hip flex and abduction
· ROM: WNL except for the following
o decreased flexion and extension in all finger MCP and IP joints
o decreased wrist flexion and extension
o decreased hip extension and abduction
· Reflexes: WNL
· Sensation:
o Decreased facial sensation
ICF Findings
· Impairments1,2,8
o Patient is has stiffening around fingers and what appears to be finger flexion contractures developing
o Patient has noticeable hard deposits palpated around UE joints
o Patient has slurred speech due to difficulty fully opening mouth. The skin around the face is thickened and has begun to cause puckering.
o Patient has dyspnea and chest pain upon exertion.
· Activity limitations1,2,8
o Patient is unable to complete activities in supine secondary to reflux symptoms
o Patient is unable to complete overhead activities due to decreased shoulder ROM.
o Patient is unable to complete more than 30 minutes of repetitive movements due to fatigue, muscle weakness, and joint pain.
· Environmental factors8
o Patient is employed as a packer at a plastics company.
o Patient is a smoker of 20 years.
Clinical Impression[edit | edit source]
Summarization of Examination Findings[edit | edit source]
Working Diagnosis and Targeted Interventions
Intervention[edit | edit source]
- 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[edit | edit source]
Findings Over time
Discussion[edit | edit source]
Summary Statement which should include related findings in the literature, potential impact on clinical practices
Related Pages[edit | edit source]
add links to related pages here
References[edit | edit source]
References will automatically be added here, see adding references tutorial.