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% Document Info
\author{bee.f (bee.f)}
\pdfinfo{
  /Title (5002-case-1.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 - Case 1 Cheat Sheet)
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\noindent
\begin{multicols}{3}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 - Case 1 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38459/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 12th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- 50 y.o., unemployed\{\{nl\}\}- L (L4/5) pain\{\{nl\}\}- Pain can radiate to buttock\{\{nl\}\}- Onset 3 weeks ago after sleeping on sofa\{\{nl\}\}- MRI in 2007 showed "degeneration at L4/5"} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{- Sharp pain, 10/10\{\{nl\}\}- Episodic throughout day\{\{nl\}\}- Stiff in the morning taking 30 minutes to ease} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{AF:}} walking, standing for long periods of time, twisting, sit to stand is most painful\{\{nl\}\} {\bf{RF:}} heat (sauna \& steam room), stretching, ibuprofen\{\{nl\}\} {\bf{AA:}} difficulty sleeping (wakes up on turning, only getting approx. 5hrs / night)} \tn 
% Row Count 12 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Extra}}\{\{nl\}\}- Has asthma (Fostair inhaler)\{\{nl\}\}- Bilateral knee meniscal surgery after injury playing tennis (still having physio, was doing cryotherapy)\{\{nl\}\}- Maternal: hypertension, asthma, osteoporosis\{\{nl\}\}- Paternal: kidney disease, IHD (ischemic heart disease)\{\{nl\}\}- Allergic to penicillin} \tn 
% Row Count 19 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Examination Findingscal}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{General observations}}\{\{nl\}\}- Hypokyphotic Cx spine\{\{nl\}\}- Hyperlordotic Lx spine\{\{nl\}\}- Hyperextended knees\{\{nl\}\}- R shoulder higher than L\{\{nl\}\}- Hypotonic glutes\{\{nl\}\}- Slight antalgia to R\{\{nl\}\}\{\{nl\}\}- Poor proprioception} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{ROM}}\{\{nl\}\}- {\bf{AROM Lx:}} RLF \& RR reproduced L sided LBP @ end range; flexion limited @ 90° due to pain\{\{nl\}\}- {\bf{PROM Lx:}} full \& pain free\{\{nl\}\}- {\bf{Hip ROM:}} R int. rot. reproduced L LBP (otherwise full \& pain free)} \tn 
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\mymulticolumn{1}{x{17.67cm}}{- {\bf{FFD:}} 31cm (better flexion than during AROM testing)\{\{nl\}\}- {\bf{SLR:}} L reproduced pain @ 50°, R tight hams. @ 70°\{\{nl\}\}- {\bf{L leg:}} longer prone \& supine\{\{nl\}\}- {\bf{L SIJ:}} stiff on springing but no pain} \tn 
% Row Count 15 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Myofascial}}\{\{nl\}\}- Tight ES bilaterally in Lx\{\{nl\}\}- L QL tight \& TTP, R QL tight\{\{nl\}\}- TTP in adductors bilaterally, quads bilaterally\{\{nl\}\}- Hip flexors TTP\{\{nl\}\}- Tight glut. med. L} \tn 
% Row Count 19 (+ 4)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Functional}}\{\{nl\}\}- Abdominal dead bug \textless{}30s w/ recruitment of accessory muscles\{\{nl\}\}- Iliopsoas \& glut. max. strength reduced bilaterally\{\{nl\}\}- Quad length test reduced on R \& caused LBP} \tn 
% Row Count 23 (+ 4)
% Row 5
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical tests}}\{\{nl\}\}- {\bf{Braggards \& Rural NTT:}} on L reproduced back pain\{\{nl\}\}- {\bf{Bonnets, Bowstrings \& all other LL NTT:}} -ve\{\{nl\}\}- {\bf{Fabere's, Kemp's, Thomas, Single-leg hyperextension:}} -ve\{\{nl\}\}- Gaeslen's \& McKenzie glide:** on L caused L LBP} \tn 
% Row Count 29 (+ 6)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Working diagnosis}}\{\{nl\}\}- Mechanical LBP complicated by L4/5 disc degeneration} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Hx}}\{\{nl\}\}- Mechanical triage\{\{nl\}\}- 10/10 pain w/ night pain potentially concerning {\bf{(not red flag specifically )}}\{\{nl\}\}- MRI findings of disc degeneration at L4/5 10 y. ago ↑ disc involvement {\bf{(doesn't mean it's the cause)}}} \tn 
% Row Count 7 (+ 5)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Disc involvement suggestions}}\{\{nl\}\}- Antalgia (position/movement to alleviate pain)\{\{nl\}\}- SLR on the L being reduced \& causing LBP\{\{nl\}\}- Braggards \& Rural NTT on the L reproducing the LBP} \tn 
% Row Count 11 (+ 4)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Lx radiculopathy:}}\{\{nl\}\}- Should be differential based on buttock pain, antalgia \& nerve tension signs {\bf{(however wouldn't be working Dx)}}\{\{nl\}\}- Monitor pt for any neurological deteriorations} \tn 
% Row Count 15 (+ 4)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Ddx for LBP with buttock pain}}\{\{nl\}\}{\bf{- Lx radiculopathy:}} numbness, weakness, tingling, spasms, reduced ROM, atrophy, postive SLR test\{\{nl\}\}{\bf{- Sciatica entrapment:}} pain, numbness, tingling, or weakness in buttock, leg, or foot\{\{nl\}\}{\bf{- Lumbar disc herniation:}} LBP that radiates into buttock, leg, or foot\{\{nl\}\}{\bf{- Spinal stenosis:}} LBP that radiates into buttock, leg, or foot, \& numbness, tingling, or weakness\{\{nl\}\}{\bf{- SI joint dysfunction:}} LBP that radiates into the buttock, hip or thigh\{\{nl\}\}{\bf{- Piriformis syndrome:}} LBP that radiates into buttock, hip, or leg\{\{nl\}\}{\bf{- Osteoarthritis:}} LBP, stiffness, reduced ROM, pain in buttock \& hip\{\{nl\}\}{\bf{- Ankylosing spondylitis:}} LBP, stiffness that radiates into buttock \& hip} \tn 
% Row Count 15 (+ 15)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Red flags for back pain (+/- radiculopathy)}}\{\{nl\}\}{\bf{- Hx of cancer:}} persistent BP that worsens over time\{\{nl\}\}{\bf{- Trauma:}} may indicate a fracture or other injury (e.g. fall or car accident)\{\{nl\}\}{\bf{- Age:}} people over 50 can have signs of spinal stenosis, degenerative disc disease, other related spine changes\{\{nl\}\}{\bf{- Fever \&/or chills:}} may indicate infection (e.g. osteomyelitis or UTI)\{\{nl\}\}{\bf{- Progressive neurological symptoms:}} BP w/ radiculopathy w/ progressive weakness, numbness, or tingling in legs/feet may indicate nerve damage/compression (prompt medical attention)\{\{nl\}\}{\bf{- Loss of bladder/bowel control:}} medical emergency \& requires immediate medical attention\{\{nl\}\}{\bf{- Severe night pain:}} may indicate more serious condition (tumour/infection)\{\{nl\}\}{\bf{- Hx of IV drug use or injection:}} may indicate spinal infection or other more serious conditions\{\{nl\}\}- {\bf{No improvement after 4 weeks of conservative care}}} \tn 
% Row Count 34 (+ 19)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Guidelines \& evidence for manual therapy in treatment of acute \& subacute LBP}}\{\{nl\}\}- Don't offer traction or acupuncture\{\{nl\}\}- Manual therapy (spinal manipulation, mobilisation, soft tissue) ONLY WITH exercise} \tn 
% Row Count 5 (+ 5)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Types of disc disease}}\{\{nl\}\}⏺ {\bf{{\emph{Herniated disc:}}}}\{\{nl\}\}- Inner portion of disc protrudes through outer layer \& can compress nearby nerve\{\{nl\}\}- {\bf{Sx \& Ssx:}} Pain, numbness \& tingling, muscle weakness, radiating pain, changes in reflexes\{\{nl\}\}⏺{\bf{{\emph{ DDD:}}}}\{\{nl\}\}- IVD breakdown over time\{\{nl\}\}- {\bf{Sx \& Ssx:}} Back pain, neck pain, pain that worsens w/ activity, neurological symptoms (in this case sciatica)\{\{nl\}\}⏺ {\bf{{\emph{Discitis:}}}}\{\{nl\}\}- (aka. IVD infection) relatively rare condition, but can cause significant pain \& discomfort\{\{nl\}\}- {\bf{Sx \& Ssx:}} Back pain, spinal tenderness, limited mobility, fever, spinal deformity or instability, neurological symptoms} \tn 
% Row Count 19 (+ 14)
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