Presented By MD. MONSUR RAHMAN MPT in Musculoskeletal Disorders

1. Case Presentation
Presented
By
MD. MONSUR RAHMAN
MPT in Musculoskeletal DisordersMPT in Musculoskeletal Disorders

2. Patient Profile
 Name:- Balwinder Singh
 Age:- 60 years
 Gender:- Female
 Occupation:- House Wife
 Address:- Ambala City
 Marital Status:- Married

3. • Chief Complaints:-
Pain on right side of the hip joint with swelling for 8 days back.

4. HISTORY OF PRESENT ILLNESS:-
• According to the patient statement she was
apparently alright 8 days back. She was fall down
from bed to floor at 4:30pm ,Date 1st
January 2018.
• After one hour she was admitted in MM Hospital by
her relatives. Now her condition is bed ridden with
no movement of the affected side ( Rt side) . Muscle
weakness of affected side.

5. • HISTORY OF PAST ILLNESS:-
• She was diabetes Mellitus and hypertension patient .It
is time of occurrence before 17-18 years. She is no
suffer childhood illness ,no influenza , no TB
history ,no chest complication. Cardiac problem–
cardiomegaly ( previous x-ray finding).

6. SOCIO-ECONOMIC HISTORY :-
She is came from higher class.
 FAMILY HISTORY:-
Her father was diabetes patient.
 PERSONAL HISTORY :-
She is no smoker and non alcoholic.

7. PAIN EVALUATION
• INTENSITY OF PAIN:- VAS Scale
mild mod severe
• NPRS:-

8. BODY CHART:-
PATTERN OF PAIN :- Continuous
TYPE OF PAIN:- Sharp,sever and intolerable.

9. AGGRAVATING FACTOR:- Changing the
position and movement of Rt hip joint during
pain.
 RELEIVING FACTORS:- Rest and no
movement of the right hip joint relieves pain

10. ON OBSERVATIONON OBSERVATION
 BUILT:- Mesomorphic
 GAIT:- patient is bed ridden for this reasion it
conn’t findout.
 DEFORMITIES:- No deformity is seen
 SCAR:- No scar is present.
Muscle bulk: Normal muscle bulk of the thigh .
Limb : Shorting of the right lower limb.

11. ON PALPATION
 TENDERNESS:- Grade iii
TEMPERATURE:- Warmth of the right hip
joint.
 SWELLING:- Tense feeling with warmth and
soft ,fluctuating swelling is present.

12. Grading tenderness on palpation
Grade i : Patient complains of pain.
Grade ii : Patient complains of pain and winces .
Grade iii : Patient winces and withdrawn the joint.
Grade iv :Patient will not allow palpation of the joint.

13. On Examination
ROM:-
Cannot be assessed the affected side due to
pain.
MANUAL MUSCLE TESTING:- Cannot be
assessed due to pain.
Movet of Hip
jt
Right side Left side
Flexion Severe Pain 110 to 120(Deg.)
Extension ,, 10 to 15(Deg.)
Abduction ,, 30 to 50 (Deg.)
Adduction ,, 30 (Deg)
Lat. Rotation ,, 40 to 60(Deg)
Med. rotation ,, 30 t0 40 (Deg.)

14. Sensory examination
Deep –normal
Superficial –normal
Reflex-Left side –normal
Right side- can't movement

15. DIFFERENTIAL DIAGNOSES
Fracture of the neck of femur.

16. SPECIAL TESTS:- Prone knee bending test and
slump test 3
 INVESTIGATIONS:-
X-Ray:-
MRI (disc prolapse at L2-L3 & L3-L4).
DIAGNOSIS:-
PIVD ?

18. MRI Shows Buldging At The Level Of L2-
l3 & L3-l4

19. TREATMENT PLAN:-
 AIMS OF TREATMENT:-
To relieve pain
To promote muscle relaxation by decreasing
paraspinal muscle spasm
To strengthen the muscles
 To increase ROM

20. Treatment:-
 To reduce pain & spasm :
I. hot packs
II. UST 0.8w/cm2 for 10 min
III.TENS 10 min
 Back strengthening exercises
I. Extension exercise for back
a) chest pull but hand at body side
b) Forearm support
c) Hand support
Core/abdominal muscle strengthening:- The
aim of these exercises is to provide more
support to the back by strengthening the
muscles of back .

21.  Patient is advise to take care of his back.
 He is advise to bend at knees rather than back to
lift heavy objects.
 He should sleep on firm mattresses to support
the curves of back.
 He should sit with proper back support.
 Exercise doing regularly.

22. THANKS