Complex neuro/ortho case..any thoughts? (Full Version)

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MiraPT -> Complex neuro/ortho case..any thoughts? (November 22, 2006 11:22:00 PM)

Last Dec pt fell off 2 step ladder and experienced a L2 compression fracture and 32% loss of height. As well, coccyx was broken. No LOC.
History of hypothyroidism, elevated lipis, cataracts, hiatus hernia, osteo, GERD. Cardio exam normal. Musculoskeletal exam shows tenderness to right shoulder.
One year later (now)...patient has gotten worse with multiple issues. DIPs of pinky fingers swollen (with arthritis) and curved inwards, ankle joints (mainly medial malleoli) are severly swollen and circulation from ankle up to distal knee is altered and VERY sensitive to the touch. Bilateral hips are extremely sore with extreme back pain. Upon attempt to palpate back, only hand was placed on back and patient immediately jumped from pain and required almost 5 minutes to recover. Pain was definetly genuine. Doctors are giving tentative diagnosis of fibromyalgia, but I feel it is something more serious. RSD was considered, but the typical signs are not present.
Any thoughts?
THere is more to the story, but I"m not completely sure what to include as I just visited this lady today and am thinking of ways to keep her active before she gets her next hospital neuro visit.




FLAOrthoPT -> Re: Complex neuro/ortho case..any thoughts? (November 23, 2006 8:56:00 AM)

psych referral yet?




Dr.Wagner -> Re: Complex neuro/ortho case..any thoughts? (November 23, 2006 4:35:00 PM)

Please include additional information

such as

Age, gender
Medications
Medical and surgical history




MiraPT -> Re: Complex neuro/ortho case..any thoughts? (November 23, 2006 9:30:00 PM)

Sorry I dont' have much info on this case. I was just asked for an opinion..
The patient is a 87 yr old Female. No psych history.
PMH: colonsocopy and gastroscopy
I don't have a list of meds, but i do know she's on a slew of pain pills, cholesterol meds, and senocot.
I will try obtain more info tomrrow.
She's a patient through homcare right now and is waiting for a referal for neurology.
thanks again




MiraPT -> Re: Complex neuro/ortho case..any thoughts? (November 24, 2006 8:00:00 AM)

edit to above post..patient is 67




Dr.Wagner -> Re: Complex neuro/ortho case..any thoughts? (November 24, 2006 9:15:00 AM)

I can only add a few ideas...this patient absolutely needs a neurologist, not to necessarily diagnose a disease but to rule them out. Furthermore, pyschiatric help would not be out of the question (I think everyone needs a touch of psychiatric help anyway), but this patient seems to have issues with anatomic and non anatomic pain and they likely feed into each other creating a 67yr old "pain machine".
This patient likely needs some sort of aquatic therapy and socialization.




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