Case Studies
Therapeutic Modalities
• For Each Case, provide the following:
• List patients problems
• Prioritize
• Set Goals
• Plan treatment
Case #1
• 21 yo, wrestler sustained a left quadriceps
contusion 4 days ago
• Subjective:
– c/o pain, weakness, and stiffness
– Reduction of symptoms following ice
• Objective
– Painful gait 5/10
– Mild localized swelling, no discoloration
– Point tender w/ no temp increase
– PROM 0 – 90; AROM 10 – 90
Case #2
• 25 yo, soccer player suffered an inversion sprain
24 hours ago; c/c inability to FWB w/o pain
• Subjective:
– Pain w/ WB and constant ache, Previous Hx
• Objective:
– Mild limp from lack of push-off during gait
– Mild swelling in lateral ankle and foot
– Point tender over ATF, mild warmth
– Full AROM; 4/10 pain w/ active movement
– Anterior Drawer Test – normal end feel, increased
pain
– MMT: 4/5 EV, 4/5 INV, 4/5 DF, 4+/5 PF
Case #3
• 43 yo patient w/ adhesive capsulitis in L shld for 5
months; improved since start of Ther Ex and Joint Mobs
• Subjective:
– Pain w/ daily activities, 60% function
– Diffuse, intermittent aching sensation in shld
• Objective:
– Pain 4/10
– No point tenderness
– L Shld AROM – ABD 0 – 80, FLX 0 – 100, ER 0 – 15, IR 0 – 20
– Reduced capsular glide (esp. ant and inferiorly)
– Scapular substitution pattern with active movement
Case #4
• 17 yo patient removed from 4 weeks of
long leg cast for Gr III MCL sprain.
Cleared to perform strengthening ex’s and
has no restrictions. Having difficulty
generating a strong quad contraction
• Subjective:
– Skiing injury, immediate dysfunction, unable to walk
– MRI – MCL rupture, small MM tear
– Immobilized at 25 of flexion for 4 weeks
– Hinged brace w/ ROM to tolerance
– WB as tolerated w/ crutches until normal gait
• Objective
– Joint line tenderness at MCL
– Pain rating 3/10
– Minimal effusion; slight thickening at suprapatellar pouch
– Quadriceps atrophy
– AROM 12 – 95
– PROM 5 - 105
Case #5
• Swimmer c/o recurrent shoulder pain,
increased over last 2 weeks. Vague,
aching sensation that somewhat resolves
with ice and rest. Heat application prior to
practice irritates the condition. c/c is pain
late in evening and night. Concerned
about upcoming Olympic Trials
• Subjective:
– Pain in R shoulder, especially during warm-up and
after practice
– Ice and exercise have decreased symptoms over the
past two weeks
• Objective:
– 8/10 at worst, 5/10 w/ activity
– Pain on palpation at posterior aspect of GH jt.
– Full AROM, PROM
– Generalized laxity at GH joint, greatest with anterior
stress
Case #6
• 73 yo retired carpenter had a TKR 15 days ago. Cleared
for rehab. Limit WB to 50% for 4 weeks. c/c is stiffness
• Subjective:
– DJD for 25 years
– Past medical Hx of hypertension, mild cv disease
– Ambulatory and PWB with crutches
• Objective:
– Incision closed and healing well
– Pain 2/10
– Moderate effusion
– Decreased patellar mobility
– Anesthetic area around incision
– AROM 18 – 93
– PROM 4 – 97
• Two weeks later continues to have a 15
active extension lag. Effusion has
decreased. How would you modify your
treatment plan.
Case #7
• 37 yo, mother of 3 is 6 wks s/p R ankle bimalleolar Fx with ORIF.
Short leg cast removed. Primary goal is independent ADL’s.
• Subjective:
– Tripped on stairs and fracture R ankle 6 wks ago
– FWB
– c/o stiffness, aching, and swelling
• Objective:
– Mild pain w/ gait, R foot turns out to accommodate for decreased ROM
– Incisions well healed; skin dry and flaky, no palpable warmth
– Pitting edema on dorsum of foot
– AROM 5 – 22 PF
– PROM 0 – 28 PF
• Insurance will cover 2 visits / week for 3 weeks
Case #8
• 19 yo, college gymnast with Grade I stable
spondylolisthesis has been cleared to
participate to tolerance. She decribes an
“achiness” in her low back before practice,
and “soreness” after practice.
• Subjective:
– Dx with spondy in HS, annual x-rays show no further
slippage
– Increased achiness with sitting for prolonged periods,
symptoms resolve with movement
– Denies radicular symptoms
• Objective:
– Palpable spasm in lumbar paraspinals
– AROM full; increased with extension
– PROM: hip flexion 0 – 110
– Symptoms increase with trunk extension