CASE PRESENTATION

BY
SAVITA NATHALIA
DEMOGRAPHIC DATA
NAME : HAMIDA
AGE : 55 YEARS
SEX : FEMALE
OCCUPATION : WASHERWOMAN
ADDRESS : YAMUNANAGAR
DATE OF ADMISSION : 23.02.2010
DATE OF ASSESSMENT : 03.03.2010
C.R. No. : 229984/718861
CHIEF COMPLAINTS
Pain in low back
Pain in both legs
Inability to stand and walk for long time
SUBJECTIVE ASSESSMENT
HISTORY OF PRESENT ILLNESS
Patient came in casualty with history of low back
ache radiating to both lower limbs, right > left since 3
years. Patient was asymptomatic 3 years back when she
developed LBA radiating to both lower limbs. No H/o
trauma or fever present. Pain gradually increased since
then.
PAIN HISTORY
Mechanism of injury: spontaneous
Predisposing factors: sustained postures
Onset: gradual
Since onset: increasing
Site: low back with radiation to both LL , r > l
Severity: level 6
Nature: sharp shooting, nagging
Body chart
Irritability: aggravating factor- activity
relieving factor- rest
Daily pattern: 24 hour pain
Duration: chronic
NPRS: 8
HISTORY OF PAST ILLNESS – hypertensive, taking
medicines for it ; non diabetic
PERSONAL HISTORY – Vegetarian
married
Socioeconomic history – lower class
DRUG HISTORY
ZERODOL P-1 BD
ACILOC 150mg- 1 BD
OSTEOFIT C- 1OD
AMLODIPINE 5mg- 1 OD
OBJECTIVE ASSESSMENT
INSPECTION
No swelling
No scar
Skin colour and texture normal
No muscle wasting
Build: mesomorphic
Posture: during standing, patient stands with poking
chin, protracted shoulders, flat cervial and thoracic
spine but lumbar lordosis is not increased
PALPATION
Temperature: normal
Tenderness: Grade 2
Spasm: mild spasm of the paraspinal muscles
EXAMINATION
MOTOR ASSESSMENT
RANGE OF MOTION AT LUMBAR SPINE
FLEXION- 1.5 inches
EXTENSION- not possible
ROTATIONS- not possible
RANGES OF MOTION
HIP
RIGHT ACTIVE/PASSIVE
 FLEXION 0-20/0-90
 EXTENSION 0/0-10
 ABDUCTION 0-25/0-45
 ADDUCTION 25-0/45-0
 IR 0-20/0-40
 ER 0-15/0-40
LEFT ACTIVE/PASSIVE
 FLEXION 0-30/0-90
 EXTENSION 30-0/90-0
 ABDUCTION 0-40/0-45
 ADDUCTION 40-0/45-0
 IR 0-35/0-40
 ER 0-35/0-40
KNEE
FLEXION- 0-130
EXTENSION- 130-0

ANKLE
DF- 0-15
PF- 0-50
INVERSION- 0-30
EVERSION- 0-15
MMT
HIP RIGHT / LEFT
 FLEXION 3/ 3
 EXTENSION 2/ 2
 ABDUCTION 3/ 3
 ADDUCTION 3/ 3
 IR 3/ 3
 ER 3/ 3
MMT
KNEE RIGHT/ LEFT
 FLEXION 3/ 3
 EXTENSION 3/ 3
ANKLE
 DF 3/ 3
 PF 3/ 3
 EHL 5
 ED 5
 FHL 5
 FDL 5
REFLEXES
KNEE + B/L
ANKLE + in L, - in R

SENSATIONS
INTACT B/L

BOWEL AND BLADDER

NORMAL
SPECIAL TESTS
STEP SIGN – present
Stork standing lumbar extension test- not possible
SLR- R- 70, L-90
INVESTIGATIONS
X- ray lumbar spine lateral view shows
spondylolisthesis grade 1 at L4-5 level.
MRI:
Grade 1 spondylolisthesis at l4-5 level
Degenerative IV discs with annular tear of l4-5 and
L5-S1 Levels.
Hypertrophied ligamentum flavum at L4-5 causing
severe spinal canal stenosis
DIAGNOSIS
DEGENERATIVE LUMBAR SPONDYLOLISTHESIS
Grade 1 AT L4-5 Level with 11% slip
PIVD at L4-5 and L5- S1 Level
TREATMENT GOALS
SHORT TERM GOALS
To relieve pain
To increase range of motion
Prevent complication like bed sore
Postural correction
LONG TERM GOALS
Strengthening of the muscles of LL
Maintainence of the gained strength
Correction of deformity
TREATMENT
BRACING : antilordotic total contact thoraco
lumbosacral moulded brace is advised to the patient.
It has to be worn continuously. Bell et al have reported
sucessful results of bracing but it has to be worn for a
period of at least 2 years.
Deep heat modality for pain relief
IFT for the radiating pain
Correct posture by maintaining flexion attitude
Strong abdominal exercises
Spinal flexion exercises
Strengthening exercises for both lower limbs
FORWARD BENDING OF TRUNK AT LUMBAR SPINE IN CHAIR SITTING WITH
STRONG ABDOMINAL CONTRACTIONS
THANK
YOU