Section Information: Abstracts of Poster and Platform Presentations for the 2004 Combined Sections Meeting: Poster Presentations
A CASE STUDY ON DIFFERENTIAL DIAGNOSIS OF LOW BACK AND FLANK PAIN IN AN ADULT WITH DEVELOPMENTAL DELAY.
J. Yee, Woods Services, Philadelphia, PA.
BACKGROUND & PURPOSE: The purpose of this poster is to present a case involving a very common diagnosis, low back and flank pain, in an adult with developmental disability whose communication skills are somewhat compromised. The use of differential diagnosis was necessary in order to determine the true cause of the back pain.
CASE DESCRIPTION: J is a 57 year old male with a history of mild mental retardation, seizure disorder, obesity, osteoarthritis, hypertension, and cervical disc disease. J presented in physical therapy with complains of low back, right flank, and right hip pain that J’s primary physician attributed to a minor fall 2 months prior to this PT examination. J’s symptoms appeared inconsistent and not dependent upon level of physical activity. It seemed counterintuitive that a minor fall could cause the symptoms of which J complained. The location of the pain also raised some concerns, as J had never before complained of flank pain that was unrelieved with medication. The physical therapist requested x-rays of J’s hip and spine from the orthopedic surgeon serving as consultant to rule out a more serious orthopedic or systemic issue. OUTCOMES: AP pelvis and frog view x-rays of hips were reviewed by the orthopedist and PT, and the x-rays were unremarkable. AP x-ray of J’s TLS spine showed a circular, 2 cm suspicious area that appeared on film to be where J’s right kidney would be. Further imaging confirmed our suspicions that it was a kidney stone. After appropriate treatment, J reported that the pain on his right side had resolved.
DISCUSSION: J was a challenging case because he does not always accurately communicate his symptoms due to his mild limits in cognition. He also has comorbidities that warrant a more cautious approach in treating and assessing his complaints. These include his hypertension and his seizure disorder and the multitude of medications that he takes. It was the responsibility of the physical therapist to try to interpret his meanings as closely as she could. Fortunately in this case, J’s chief complaint of flank pain and his clinical presentation was different enough to warrant further examination, and the imaging clearly showed a systemic cause of J’s symptoms. This case illustrates the importance of the physical therapist s role in the differential diagnosis and medical screening process.