|
|
Case: 19 year old with back pain
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Case: 19 year old with back pain - August 14, 2006 3:54:00 AM
|
|
|
Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
A 19 year old female presents with back pain for 2 days. She is a college student at the local university that has recently moved into the dorms prior to the beginning of classes.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 6:16:00 AM
|
|
|
USAPT
Posts: 277
Joined: January 14, 2004
Status: offline
|
Was it sudden onset?
Recall how it happened?
Where is the pain?
Is is sharp, dull, achy?..localized?
Is it getting better/worse since injury?
What makes it better/worse?..change w/ movements?
okay, i'll stop for now and wait for a response.
_____________________________
Jason, PT
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 7:34:00 AM
|
|
|
Shill
Posts: 1059
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
PMH and back/neck pain history please.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 7:35:00 AM
|
|
|
Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
The pain is "dull", but there are "sharp" aspects as well. It seems to encompass the lumbar region, specifically T10-L3.
She woke up with it two days after moving into the dorms.
Does it change with movement...she states "I have had to lay on my side most of the day"
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 9:29:00 AM
|
|
|
USAPT
Posts: 277
Joined: January 14, 2004
Status: offline
|
meds?
is it getting better or worse?
_____________________________
Jason, PT
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 9:37:00 AM
|
|
|
USAPT
Posts: 277
Joined: January 14, 2004
Status: offline
|
meds?
is it getting better or worse?
_____________________________
Jason, PT
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 11:10:00 AM
|
|
|
Jeffre
Posts: 130
Joined: August 18, 2005
From: Lafayette, LA
Status: offline
|
Does her back hurt the next day after she drinks alchohol alot? Sexually active? Any other students in the dorm have similar problems?
_____________________________
"You are as well as your insurance company is willing to allow."
- Dr. Hibbert
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 1:20:00 PM
|
|
|
Synergy
Posts: 589
Joined: March 11, 2004
From: Forney, TX
Status: offline
|
Well, she just moved in two days prior to the onset of pain so one can assume she was carrying a bunch of objects...perhaps some heavy objects carried improperly (poor mechanics). Did she have to take the stairs...lugging all her stuff? Prior instances of LBP, menstrual problems, etc.
_____________________________
Chris Adams, PT, MPT
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 2:42:00 PM
|
|
|
jma
Posts: 2319
Joined: August 24, 2000
From: NY
Status: offline
|
On which side of her back is the pain located? Is it localized or is it diffused? On which side does she sleep on? Does the pain aggravate with eating?
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 5:20:00 PM
|
|
|
eam
Posts: 289
Joined: February 5, 2004
From: New York, NY 10028
Status: offline
|
Is she pregnant? Is she a gymnast, dancer? What makes it worse? Body type? Has she self administered ice or taken OTC meds and if so, did they help?
Erica
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 9:13:00 PM
|
|
|
Randy Dixon
Posts: 744
Joined: August 6, 2004
Status: offline
|
If this patient came into a PT clinic I think we'd find some of what we are looking for in a typical examination. Reflexes, ROM, restrictions, other complaints. First things first, I'd want to know her vitals, look for things like high temperature, abnormal BP, signs of flu or illness, HR, observe her eyes, ask about BM's etc. Then I'd palpate the abdomen, looking for tenderness or hardness. Same with the painful area, looking for redness, heat, swelling, tenderness, bumps, bruises, etc.
Once I get an idea if it is musculoskeletal or something else I'd go from there.
|
|
|
|
|
Re: Case: 19 year old with back pain - August 14, 2006 11:58:00 PM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Don't mean to sound flippant but what is her mattress like?
If she has gone from a comfy home bed to a dubious mattress in a dorm, the thoracolumbar region may not like it...
Nari
|
|
|
|
|
Re: Case: 19 year old with back pain - August 15, 2006 1:19:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1116
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
Kidney or liver function? (IN addition to all the above - reasonable and common history questions)
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: Case: 19 year old with back pain - August 15, 2006 4:33:00 AM
|
|
|
srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
Status: offline
|
does it hurt after or before eating?
|
|
|
|
|
Re: Case: 19 year old with back pain - August 15, 2006 11:52:00 AM
|
|
|
jbird007
Posts: 297
Joined: May 2, 2006
From: USA
Status: offline
|
Doc Wags said: "she states "I have had to lay on my side most of the day"
This grabs my attention. My questions would focus here for a bit. :)
Is this so severe that she has serious difficulties walking? How intense is the pain?
I would first try and rule out all the serious complications such as ectopic pregnancy,kidney stones/infection, internal bleed, other visceral disorders, vertebral compression fracture(yes, young thin females are a risk for osteoporosis), etc.
JBird
|
|
|
|
|
Re: Case: 19 year old with back pain - August 21, 2006 8:59:00 AM
|
|
|
Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
I apologize for the wait...my computer crashed so I had to buy a new one.
Anyway,
vitals temp 100,HR 90,BP 110/75, rr17
she notes the pain is sharp and any palpation on that side causes pain, including movement to that side.
She states, that while "I did very little in the moving process" she was "much more sore when she woke up the next day...even a little nauseated"
Her mattress is from Costco...other than that she knows very little about it.
A blood test is ordered
Creatinine is .8
BUN 11
K 3.6
Na 136
Cl 106
CO2 25
Glucose 90
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: Case: 19 year old with back pain - August 22, 2006 1:34:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1116
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
Doc Wagner, I tried to find IF you had mentioned which side - can't see it anywhere. Could be significant (i.e. spleen - liver etc.). I'll try to make sense of the lab results....
_____________________________
Mundi vult decipi
|
|
|
|
|
Re: Case: 19 year old with back pain - August 22, 2006 8:53:00 AM
|
|
|
Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
right side of thoraco lumbar junction
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
Re: Case: 19 year old with back pain - August 22, 2006 9:39:00 AM
|
|
|
USAPT
Posts: 277
Joined: January 14, 2004
Status: offline
|
nausea, back pain worse next morning, lifting, pain with movement to that side...check for hernia?
_____________________________
Jason, PT
|
|
|
|
|
Re: Case: 19 year old with back pain - August 22, 2006 10:54:00 AM
|
|
|
Sebastian Asselbergs
Posts: 1116
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
Did she drink lots (ETOH of course) the first few days following the arrival at college?
_____________________________
Mundi vult decipi
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.125
|
Printable Version
