Name That Dx
Lateral elbow pain with gripping. Tender just distal to the lateral epicondyle, with pain on resisted wrist and middle-finger extension.
Lateral elbow tendinopathy
New low back pain with saddle anesthesia and new urinary retention.
Cauda equina syndrome
A 24 y/o soccer player has an inversion ankle sprain from 2 days ago. There’s lateral swelling and tenderness over the ATFL, and the patient can bear weight with pain. Ottawa rules are negative. Which intervention is MOST appropriate?
A) Non-weight bearing on crutches for 2 weeks
B) Therapeutic ultrasound
C) Cast immobilization for 10 days
D) Functional bracing with early protected weight bearing and ROM exercise
D
Positive Phalen’s, Tinel’s at the wrist, and carpal compression test, with diminished sensation in the thumb, index, and middle fingers.
Carpal Tunnel Syndrome
Runner with sharp heel pain that’s worst on the first steps in the morning. Tender at the medial calcaneal tubercle.
Plantar fasciitis
Sprinter with deep buttock pain at the ischial tuberosity that worsens with prolonged sitting and hill sprints. Pain is reproduced with a bent-knee hamstring stretch.
Proximal hamstring tendinopathy
Calf pain, swelling, and warmth 10 days after a TKA.
Deep vein thrombosis
A 68 y/o with bilateral knee OA reports difficulty rising from a chair and climbing stairs. Quadriceps strength is 3+/5 bilaterally and knee ROM is 5–115°. The goal is to walk 1 mile with grandchildren. Which intervention should the PT prioritize?
A) Grade III tibiofemoral mobilization into extension
B) NMES to the quadriceps
C) Progressive quadriceps strengthening
D) Single-point cane
C
Positive Lachman, anterior drawer, and pivot shift.
ACL Tear
22 y/o with diffuse anterior knee pain on stairs, squatting, and prolonged sitting. No effusion, ligaments intact.
Patellofemoral Pain Syndrome
Foot drop with weak dorsiflexion, great toe extension, and eversion, but inversion and hip abduction are strong. Tinel’s is positive at the fibular head.
Common fibular neuropathy
63 y/o with neck pain, clumsy hands, a wide-based gait, and a positive Hoffmann sign.
Cervical myelopathy
A 55 y/o woman has 2 weeks of lateral hip pain, worse lying on the affected side and climbing stairs. Pain is reproduced with greater trochanter palpation and 30 seconds of single-leg stance. She does a daily standing ITB stretch, crossing the affected leg behind. Which intervention is MOST appropriate initially?
A) Side-lying hip abduction with ankle weights
B) Iontophoresis with dexamethasone
C) Progress the ITB stretch
D) Isometric hip abduction in neutral, plus education to avoid adducted postures
D
Positive Spurling’s, cervical distraction, median nerve ULTT, and cervical rotation under 60°.
Cervical Radiculopathy
A 20 y/o fell on an outstretched hand. There’s tenderness in the anatomical snuffbox and pain with axial loading of the thumb, and same day wrist radiographs are normal.
Scaphoid fracture.
Police officer with burning and numbness over the anterolateral thigh, worse when in police gear. Strength and reflexes are normal.
Meralgia paresthetica (LFCN entrapment)
Sudden severe neck pain and headache, with dizziness, diplopia, dysarthria, and nystagmus.
A 42 y/o warehouse worker with 8 months of LBP has had 6 visits of lumbar mobilization with no change. The patient says, “I’m afraid lifting will damage my spine,” and avoids bending. No red flags, and the PHQ-2 is negative. What is the MOST appropriate next step?
A) Refer to a psychologist
B) Graded exposure to lifting and bending, with pain education
C) Refer to the physician for imaging
D) Lumbar stabilization in neutral spine
B
Squatting aggravates symptoms, active hip flexion causes hip pain, scour test positive, active hip extension is painful, and passive IR is 20 degrees
Hip OA
55 y/o woman with lateral hip pain lying on that side. Tender at the greater trochanter, with pain reproduced by 30 seconds of single-leg stance.
Greater Trochanteric Pain Syndrome
A 35 y/o woke with severe shoulder pain two weeks after a viral illness. The pain resolved over about 10 days, then scapular winging and external rotation weakness appeared. Cervical exam is unremarkable.
Parsonage-Turner Syndrome
A 19 y/o football player was kicked in the shin. A few hours later he has severe pain out of proportion to the injury, a tense anterior leg, pain with passive toe flexion, and tingling in the first web space.
Acute anterior compartment syndrome. Needs emergency referral.
A 13 y/o boy with an elevated BMI has had 4 visits for anterior knee pain diagnosed as patellofemoral pain, with no improvement. He now walks with an antalgic gait. Hip IR is markedly limited, and the thigh externally rotates when his hip is passively flexed. What is the MOST appropriate next step?
A) Add hip abductor and external rotator strengthening
B) Patellar taping to reduce pain during activity
C) Refer for hip radiographs
D) Progress quadriceps strengthening to closed chain
C
Limited elbow pain elbow flexion and extension range of motion, hypmobility of the humeroulnar joint, weakness with wrist extension. Limited cervical spine extension and ipsilateral rotation. Lateral elbow pain with cervical quadrant and C5/6 UPA.
Cervical facet joint arthropathy
A 30 y/o can’t make an “OK” sign, so the tip-to-tip pinch collapses into a pad-to-pad pinch. Thumb IP flexion and index DIP flexion are weak, and sensation is completely normal.
Anterior Interosseous Nerve Syndrome