BY SAVITA NATHALIA

DEMOGRAPHIC DATA
y NAME y y y y y y y

: 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 yPain in low back yPain in both legs yInability to stand and walk for long time .

SUBJECTIVE ASSESSMENT .

No H/o trauma or fever present. right > left since 3 years.HISTORY OF PRESENT ILLNESS Patient came in casualty with history of low back ache radiating to both lower limbs. Patient was asymptomatic 3 years back when she developed LBA radiating to both lower limbs. Pain gradually increased since then. .

PAIN HISTORY y Mechanism of injury: spontaneous y Predisposing factors: sustained postures y Onset: gradual y Since onset: increasing y Site: low back with radiation to both LL . nagging . r > l y Severity: level 6 y Nature: sharp shooting.

Body chart .

y Irritability: aggravating factor.activity relieving factor.rest y Daily pattern: 24 hour pain y Duration: chronic y NPRS: 8 .

taking medicines for it .y HISTORY OF PAST ILLNESS hypertensive. non diabetic y PERSONAL HISTORY Vegetarian married y Socioeconomic history lower class .

1OD y AMLODIPINE 5mg.1 BD y OSTEOFIT C.1 OD .DRUG HISTORY y ZERODOL P-1 BD y ACILOC 150mg.

OBJECTIVE ASSESSMENT .

flat cervial and thoracic spine but lumbar lordosis is not increased . patient stands with poking chin.INSPECTION y No swelling y No scar y Skin colour and texture normal y No muscle wasting y Build: mesomorphic y Posture: during standing. protracted shoulders.

PALPATION y Temperature: normal y Tenderness: Grade 2 y Spasm: mild spasm of the paraspinal muscles .

5 inches y EXTENSION.EXAMINATION y MOTOR ASSESSMENT y RANGE OF MOTION AT LUMBAR SPINE y FLEXION.1.not possible y ROTATIONS.not possible .

RANGES OF MOTION HIP RIGHT y FLEXION y EXTENSION y ABDUCTION y ADDUCTION y IR y ER ACTIVE/PASSIVE y 0-20/0-90 y 0/0-10 y 0-25/0-45 y 25-0/45-0 y 0-20/0-40 y 0-15/0-40 .

LEFT y FLEXION y EXTENSION y ABDUCTION y ADDUCTION y IR y ER ACTIVE/PASSIVE y 0-30/0-90 y 30-0/90-0 y 0-40/0-45 y 40-0/45-0 y 0-35/0-40 y 0-35/0-40 .

0-130 y EXTENSION.130-0 ANKLE y DF.0-15 .0-30 y EVERSION.KNEE y FLEXION.0-50 y INVERSION.0-15 y PF.

MMT HIP y FLEXION y EXTENSION y ABDUCTION y ADDUCTION y IR y ER RIGHT / LEFT y 3/ 3 y 2/ 2 y 3/ 3 y 3/ 3 y 3/ 3 y 3/ 3 .

MMT KNEE y FLEXION y EXTENSION RIGHT/ LEFT y 3/ 3 y 3/ 3 y 3/ 3 y 3/ 3 y 5 y 5 y 5 y 5 ANKLE y DF y PF y EHL y ED y FHL y FDL .

in R SENSATIONS INTACT B/L BOWEL AND BLADDER NORMAL . .REFLEXES y KNEE y ANKLE y + B/L y + in L.

R.not possible y SLR. L-90 .SPECIAL TESTS y STEP SIGN present y Stork standing lumbar extension test.70.

Hypertrophied ligamentum flavum at L4-5 causing severe spinal canal stenosis . MRI: Grade 1 spondylolisthesis at l4-5 level Degenerative IV discs with annular tear of l4-5 and L5-S1 Levels.ray lumbar spine lateral view shows y y y y spondylolisthesis grade 1 at L4-5 level.INVESTIGATIONS y X.

S1 Level .DIAGNOSIS y DEGENERATIVE LUMBAR SPONDYLOLISTHESIS Grade 1 AT L4-5 Level with 11% slip y PIVD at L4-5 and L5.

TREATMENT GOALS y SHORT TERM GOALS y To relieve pain y To increase range of motion y Prevent complication like bed sore y Postural correction .

y LONG TERM GOALS y Strengthening of the muscles of LL y Maintainence of the gained strength y Correction of deformity .

Bell et al have reported sucessful results of bracing but it has to be worn for a period of at least 2 years. y Deep heat modality for pain relief y IFT for the radiating pain .TREATMENT y BRACING : antilordotic total contact thoraco lumbosacral moulded brace is advised to the patient. It has to be worn continuously.

y Correct posture by maintaining flexion attitude y Strong abdominal exercises y Spinal flexion exercises y Strengthening exercises for both lower limbs .

FORWARD BENDING OF TRUNK AT LUMBAR SPINE IN CHAIR SITTING WITH STRONG ABDOMINAL CONTRACTIONS .

THANK YOU .

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