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Differential Diagnosis

Orthopedic Injury or Oncologic Process—A Case Report

Cobb, Lorene, PT, DPT, MS, PCS1; Galantino, Mary Lou, PT, MS, PhD, MSCE1,2

doi: 10.1097/01.REO.0000000000000083

Background and Purpose: Patients referred for orthopedic management of musculoskeletal conditions warrant careful consideration when linear progress or decline is observed.

Case Description: A 17-year-old male high school baseball player was referred by an orthopedic surgeon with a diagnosis of right medial epicondylitis. Physical therapy history, examination, and differential diagnosis led to “red flag” identification and a referral back to the orthopedic surgeon for diagnostic imaging. After negative findings, the patient returned for continued treatment of right medial epicondylitis. Upon a second physical therapy evaluation, symptoms progressed and functional capabilities decreased. This prompted the physical therapist to refer the patient and his family for additional medical examination.

Outcomes: Review of previous diagnostic imaging led to the diagnosis of a primary osteoblastoma, surgical intervention, and physical therapy, with a quick return to independent functioning. Within 4 months, the aggressive tumor returned, which prompted referral to an orthopedic tumor specialist, and the patient underwent a second more extensive surgery and within a year, a third, most aggressive surgical procedure. He continues to receive medical and physical therapy follow-up visits and has not returned to competitive sports.

Discussion/Conclusion: Physical therapists consistently demonstrate the ability to be extremely competent, efficient, and cost-effective in managing neuromusculoskeletal dysfunction. It is imperative to recognize signs, symptoms, and “red flags,” which indicate pathological conditions outside the scope of physical therapy practice, and ensure prompt and appropriate referrals.

1Director of Clinical Education, Doctor of Physical Therapy Program, School of Health Sciences, School of Health Sciences, Stockton University, Galloway, NJ

2Professor of Physical Therapy, Doctor of Physical Therapy Program, School of Health Sciences, Stockton University, Galloway, NJ; University of Pennsylvania, Philadelphia, PA; and University of Witwaterstrand, Johannesburg, South Africa

Correspondence: Lorene Cobb, PT, DPT, MS, PCS, School of Health Sciences, Stockton University, 101 Vera King Farris Dr, Galloway, NJ 08025 (

The authors declare no conflicts of interest.

Copyright 2019 © Academy of Oncology Physical Therapy, APTA
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