Weekend 6 Case Presentation

[Matt Fung]

Please see file attached below for weekend 6 case presentation.

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[jeffpeckins]

Questions:
1. Based on the subjective information presented above what are your top three differential diagnoses? (Ranking order)
– Gluteal tendinopathy
– FAI
– Lumbar discogenic pain with referral

2. Based on the objective information presented above what is your top clinical diagnosis and why? Does it follow a clinical pattern?
– Gluteal tendinopathy: Pain location in hip with lateral LE referral. Aggs are holding baby (likely hip-ABD position to support child’s weight), SLS, crossing legs, laying on R side. Wide hips. Pain with SL squat. Pain with hip ER PROM and pain with initiating hip ER in lengthened position, pain with resisted hip ER and ABD. TTP glute med insertion.

3. Is there any information you would have asked during the subjective examination or
collected during the objective examination?
– Generally more info on groin pain, and if this pain increases with either the LBP or hip pain.
– May have thrown in a prone instability test for palpation/mobility testing.
– Mobility of the segments above L4-5
– Which pain did FABER reproduce?

4. What would have been your exercise prescription and educational interventions for day one?
– Supine hip ABD/ER isometrics (hooklying TB around knees)
– Education on sleeping and standing positioning for decreased compression of gluteal tendon

[Erik Kreil]

Hey Matt, nice job here.

Questions:
1. Based on the subjective information presented above what are your top three differential diagnoses? (Ranking order)
– SIJ
– Trochanteric brusitis
– L4/5 radic

2. Based on the objective information presented above what is your top clinical diagnosis and why? Does it follow a clinical pattern?
– It sounds like an L4/5 radic with concurrent ipsilateral glute tendinopathy/ insertional bursitis. L4/5 radic could be playing a role in the firing of glute tissue. Her LS and buttock was recreated with LS extension/ Quadrants and CPA to L4/5… painful laying on ipsilateral trochanter, poor use of hip stabilizing glutes with SLS, lunge, and clamshell recreating hip pain.

3. Is there any information you would have asked during the subjective examination or
collected during the objective examination?
– More neuro screening.. reflexes, SLR, SLR + SIJ compression
– More info on function testing… was she dumping into LS lordosis, since you noted she even stands in anterior pelvic tilt?
– Aggs/ eases specific to each region… low back, buttock, anterolateral hip, groin.
– With more information, she may fit into the CPR for successful lumbar stabilization tx

4. What would have been your exercise prescription and educational interventions for day one?
– Education: dial down her exercise moves to the ones she can handle without form exception or sx recreation, for now.
– Exercises: substitute the exercises removed with ones that will build where she needs (DLS with ER resistance if painfree, “Captain Morgan” SLS iso ER at a wall, etc)
– Manual: consider a S/L lower lumbar segmental flexion technique for mobility and pain relief

[Cameron Holshouser]

1. Based on the subjective information presented above what are your top three differential
diagnoses? (Ranking order)

– Myofascial referral (glute med/lumbar multifidi)
– SIJ dysnfunction
– Pelvic floor dysfunction
– Lumbar clinical instability

2. Based on the objective information presented above what is your top clinical diagnosis
and why? Does it follow a clinical pattern?

– Right glute med tendinopathy

o SL squat deviations and pain
o SL stance pain and unable to stand for 30 seconds
o Pain with palpation of glute tendon and muscle
o MMT: hip abd and ER pain and weakness
o Negative lumbar and SIJ tests

3. Is there any information you would have asked during the subjective examination or
collected during the objective examination?

– Ober’s test
– Pelvic floor special questions
– Birth questions (i.e. complications?)
– Previous hip pain, pregnancies, back pain?
– Imaging?
– Chiropractic treatment interventions
– Prior history?
– SLR
– SLR with compression
– Prone instability test
– Beighton scale
– Prone LE activation

4. What would have been your exercise prescription and educational interventions for day
one?

– Positions to avoid for glute tendon compression
– Sleeping positions
– Frequent and prolonged clamshell isometrics in side lying, different angles

[Author]

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