July- Red Flag Case Management

[Kyle Feldman]

This was a patient I saw in July 2020.

A 35 year old female presented for her 3rd PT visit. Her chief compliant had been SIJ pain with some pain in the groin region. So far manual treatment and exercise had reduced pain slightly. She was also educated to wear an SIJ belt due to this being her 3rd bout of SIJ pain since her last pregnancy in 2011.
When she presented to the clinic today, she looked bloated and reported new symptoms.
She reported that three days prior she began to have numbness in the groin region and some pain with urination. She went to her OBGYN the next day and at the visit she expressed concern of fullness. The MD catharized her and was able to extract 12 urine sample containers full of urine. They told her to follow up with her PCP and sent her home.

I will tell you what happened after everyone responds.

Please read this article and save!

What are you going to do on this visit today?

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[Farisshd]

This change in status would raise concern for CES, spinal fracture, or obstruction d/t tumor. With the new symptoms and confirmed urinary retention, I would recommend emergency referral for MRI and medical management.

[zcanova]

For this visit I would first inquire about possible red flag differentials including cancer, infection/UTI, cauda equina and upper motor neuron pathology. Key questions would include; frequency/timeline/nature of symptoms, difficulty and/or pain urinating, recent signs of infection (fatigue, night sweats, fever), unrelenting night pain, saddle paresthesia’s, flank pain, unexpected weight loss, unilateral or bilateral LE pain/weakness/sensation loss, and individual/family history of cancer. If I suspected cauda equina or UMN pathology I would proceed with a neurological screen (dermatome, myotome, reflexes, UMN testing and cranial nerve testing). Based on the information currently provided in the prompt my differential would include cancer (kidney, bone), infection (spinal, kidney/UTI), and cauda equina. With these differentials I would likely refer this patient to the ER for advanced imaging to rule out serious pathology before proceeding with treatment.

[Kyle Feldman]

Great answers.
I was shocked and sent her to the ER.
After 3 hours, they cath-ed her and sent her home.
I could not believe it!!

I used a connection in NOVA and we got her seen in an ER there. She had an MRI performed and they found a mass in her sacrum. It was a spread of cancer

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