Upper Extremity
Patient presents to the clinic with shoulder pain and weakness after a wrestling match yesterday. There is a visible shoulder deformity, positive sulcus sign, and patient has limited ROM and strength. They have numbness and tingling in the tips of their fingers. Should you order imaging?
Yes, because there are signs of potential shoulder dislocation.
Patient presents to the clinic with left knee pain and instability after a contact injury during a basketball game. There is a loud 'pop' reported at the time of injury, immediate swelling, and a positive Lachman and anterior drawer test. Should you order imaging? What kind of imaging?
Yes, an MRI should be ordered because of the potential ACL tear.
Patient presents to the clinic with severe low back pain, bilateral leg weakness, numbness in the saddle region, and new-onset urinary incontinence. Symptoms developed rapidly over 24 hours. Should you order imaging?
Yes, because there is a potential for cauda equina syndrome.
Patient presents to the clinic with lateral elbow pain after playing pickleball 2 weeks ago. They have limited ROM, some limited strength, and no numbness or tingling. Wrist flexion and elbow extension cause 3/10 pain. Should you order imaging?
No, there are no significant red flags that could indicate further pathologies.
Patient presents to the clinic with new-onset left calf pain and swelling, three weeks after knee replacement surgery. The calf is tender, warm, and visibly swollen. There is a positive Homan's sign. Should you order imaging?
Yes, because there is a potential risk for a DVT.
Patient presents to the clinic with neck stiffness and increased pain while driving for the past 2 months. They deny headaches and numbness and tingling in the upper extremity. The ROM and strength of the cervical neck is limited due to pain. Should you order imaging?
No, because there are no red flags of cervical involvement.
Patient presents to the clinic through direct access with wrist pain following a FOOSH fall 2 days prior. There is bruising and swelling on the lateral wrist and tenderness to palpation of scaphoid and surrounding structures. Should you order imaging?
Yes, the symptoms point to a potential scaphoid fracture, and as a direct access PT, you are the first one seeing this patient.
Patient presents to the clinic with severe right ankle pain after rolling her ankle during a tennis match. There is swelling, lateral malleolar tenderness, and inability to bear weight. Anterior drawer test is positive. Should you order imaging?
Yes, because there is potential for a ligament injury or ankle fracture.
Patient presents to the clinic with chronic low back pain that has been persistent for 1 year. The pain will increase to a 3/10 while golfing or walking long distances, but at rest, the pain is a 1/10. They have limited ROM with lumbar extension and have generalized weakness of the major muscles in the hips.
No, because this patient does not have any red flags for medical emergency signs.
Patient presents to the clinic with shoulder pain and persistent weakness when lifting objects. There is palpation to tenderness of anterior lateral shoulder with positive drop arm test, Hawkins Kennedy test, full can and empty can test. Should you order imaging? What kind of imaging?
Yes, you should order an MRI, because there is a potential rotator cuff tear.
Patient presents to the clinic with right knee pain and intermittent locking after a pivoting injury while playing soccer two weeks ago. There is tenderness along the medial joint line, mild effusion, and pain with McMurray's test. Should you order imaging? What kind of imaging?
Yes, an MRI should be order, because of the potential meniscus tear.
Patient presents to the clinic with low back pain radiating down the left leg to the foot, following a heavy lifting injury 1 week ago. Pain is sharp and worsens with sitting and coughing. Positive straight leg raise nerve glide on the left. There is decreased sensation in the L5 dermatome, increased reflexes, and mild foot dorsiflexion weakness. Should you order imaging?
Yes, because there is signs for a potential lumbar herniated disc.
Patient presents to the clinic with shoulder, chest, and collar bone pain after FOOSH fall over the weekend. There is tenderness to palpation of the clavicle with a protrusion on the lateral end and pain with all shoulder ROM. They are unable to elevate the arm past 45 degrees without severe pain.
Yes, there is a potential clavicular fracture, because of the tenderness and pain with any shoulder movement.
Patient presents to the clinic with sudden onset of pain in the posterior right ankle after a recreational basketball game. He describes feeling like there was a snap in the back of the leg. There is difficulty walking, swelling over the Achilles tendon, and a palpable gap just above the heel. The Thompson test is positive. Should you order imaging?
Yes, because there is a potential for an Achilles tendon rupture.
Patient presents to the clinic with neck pain, bilateral hand numbness, and clumsiness when buttoning shirts. He also reports occasional unsteadiness while walking. Positive Hoffmann’s sign and hyperreflexia in upper extremities. Should you order imaging? What kind of imaging?
Yes, an MRI should be ordered, because the symptoms point to a potential cervical myelopathy.