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\author{bee.f (bee.f)}
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  /Title (5002-case-10.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 10 Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 10 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38542/}}}
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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 14th 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
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\mymulticolumn{1}{x{17.67cm}}{- 67 y.o., pensioner\{\{nl\}\}- Difficulty walking, causing pain in the lower back, R buttock \& R groin\{\{nl\}\}- Slight limp when the pain gets worse\{\{nl\}\}- In the last month, has only been playing 9 instead of 18 holes\{\{nl\}\}- Difficulty keeping w/ his friends \& doesn't enjoy golf as much} \tn 
% Row Count 6 (+ 6)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{- Limbo-sacral area (R\textgreater{}L), R buttock R groin\{\{nl\}\}- Lately been feeling pain in R knee\{\{nl\}\}- Onset gradual over last 3 months\{\{nl\}\}- Pain \& stiffness\{\{nl\}\}- 5/10\{\{nl\}\}- Getting worse\{\{nl\}\}- No clear pattern; depends on activity} \tn 
% Row Count 11 (+ 5)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{AF:}} pain \& stiffness usually start after walking 2-3 holes, but gradually increase as he plays more holes\{\{nl\}\}- {\bf{RF:}} sitting after a round of golf diminishes the pain after a while\{\{nl\}\}- {\bf{AA:}} Lately sometimes struggles to finish 9 holes} \tn 
% Row Count 16 (+ 5)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Extras}}\{\{nl\}\}- Stopped smoking at 40 y.o. (previously 10-20 cigarettes / day for 20 yrs)\{\{nl\}\}- 2 pints of beer / night\{\{nl\}\}- Father: diagnosed w/ Parkinson's disease @ 74 y.o.\{\{nl\}\}- Mother: diagnosed w/ RA \& had knee replacement @ 84 y.o.} \tn 
% Row Count 21 (+ 5)
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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
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Gait}}\{\{nl\}\}- Slight limp on R} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{ROM}}\{\{nl\}\}- {\bf{AROM \& PROM Lx:}} slightly reduced flexion \& rotation (R) w/ some discomfort in his lower back \& R buttock @ end range\{\{nl\}\}- {\bf{PROM hips:}} internal \& external rotation of R hip reduced by approx 25\% compared to L, w/ pain felt in the R groin; hip flexion \& extension slightly limited \& painful on R} \tn 
% Row Count 8 (+ 7)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{R glut palpations:}} tender locally \& reproduces some pain into R leg towards his knee} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Iliopsoas:}} tight bilaterally (R\textgreater{}L)} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{SLR}}\{\{nl\}\}- 65° bilaterally w/ some pulling at hamstrings} \tn 
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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\}\}- Hip OA\{\{nl\}\}- Associated w/ mechanical LBP \& myofascial pain syndrome (compensation for the hip)} \tn 
% Row Count 3 (+ 3)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{- Sx aggravated w/ activity \& relieved w/ rest\{\{nl\}\}- Triage: mechanical / degenerative} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Hip joint}}\{\{nl\}\}- Doesn't normally refer pain to low back ∴ unlikely cause of the back pain\{\{nl\}\}- Can refer to the knee (\& vice-versa) ∴ could be the cause of leg pain towards the knee\{\{nl\}\}→ But pain was reproduced by palpation of gluteal muscles suggesting active trigger points} \tn 
% Row Count 11 (+ 6)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentials}}\{\{nl\}\}- {\bf{Vascular claudication:}} pain in thigh, calf, or buttocks that happens when walking\{\{nl\}\}- {\bf{Inguinal hernia:}} most common hernia; swelling/lump in groin or enlarged scrotum\{\{nl\}\}- {\bf{Hip dysplasia:}} acetabulum is too shallow to support femoral head; females more affected\{\{nl\}\}- {\bf{Femoroacetabular impingement (FAI):}} extra bone growth of joint causing rubbing against each other\{\{nl\}\}- {\bf{Labral tears the hip:}} injury to tissue that holds hip joint together; pain, reduced ROM, sensation of hip {\emph{locking-up}}} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Previous Hx}}\{\{nl\}\}- LBP \& R leg pain below the knee, worse eon sitting: suggest prior Hx of radicular pain or radiculopathy\{\{nl\}\}→ Current presentation doesn't have the same pattern\{\{nl\}\}- Radiculopathy due to disc herniation {\bf{less likely}}: pain is relieved by sitting, no SMR findings \& pain doesn't follow a dermatomal pattern} \tn 
% Row Count 29 (+ 7)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{What other exams could have been conducted?}}\{\{nl\}\}- {\bf{Respiratory exam:}} former heavy smoker for 20 yrs\{\{nl\}\}- {\bf{Knee examination:}} referred hip pain to knee, \& vice-versa} \tn 
% Row Count 33 (+ 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{Differentials for LBP w/ buttock pain}}\{\{nl\}\}- {\bf{Muscle strain:}} results from lifting heavy objects, poor posture, or sudden movements\{\{nl\}\}- {\bf{Sciatica:}} can cause sharp shooting pain from lower back through buttocks \& down the legs\{\{nl\}\}- {\bf{Herniated disc:}} can cause localised pain as well as radiating pain into buttocks \& legs\{\{nl\}\}- {\bf{Spinal stenosis:}} narrowing of spinal canal; can cause LBP w/ buttock \& leg pain that worsens w/ walking or prolonged sitting\{\{nl\}\}- {\bf{SIJ dysfunction:}} (or inflammation) can cause pain in lower back \& buttocks\{\{nl\}\}- {\bf{Piriformis syndrome:}} tight or spasms, it can compress sciatica nerve; can cause buttock pain that may radiate down the leg\{\{nl\}\}- {\bf{Spondylolisthesis:}} forward displacement of one vertebra over another; can cause lower back pain as well as buttock pain \& may be accompanied by leg Sx if nerve roots are affected\{\{nl\}\}- {\bf{Inflammaotry conditions:}} e.g. ankylosing spondylitis (type of arthritis affecting spine); can cause chronic LBP \& buttock pain (particularly in young adults)\{\{nl\}\}- {\bf{Infection:}} e.g. osteomyelitis (bone infection) or disci tis (disc infection); can cause LBP w/ other Sx like fever \& swelling} \tn 
% Row Count 24 (+ 24)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Pathophysiology of OA}}\{\{nl\}\}⏺ {\bf{{\emph{Mechanical stress:}}}}\{\{nl\}\}- Repetitive mechanical stress causing micro trauma to cartilage \& breakdown\{\{nl\}\}- Abnormal joint mechanics, as above\{\{nl\}\}⏺ {\bf{{\emph{Inflammation:}}}}\{\{nl\}\}- Inflammatory cytokines can cause cartilage breakdown \& joint inflammation\{\{nl\}\}⏺ {\bf{{\emph{Age:}}}}\{\{nl\}\}- Ability for cartilage to repair itself decreases w/ age\{\{nl\}\}- More susceptible to damage \& breakdown\{\{nl\}\}⏺ {\bf{{\emph{Genetic:}}}}\{\{nl\}\}- Predispositions of OA\{\{nl\}\}- Gene abnormalities involved in cartilage metabolism or inflammation\{\{nl\}\}⏺ {\bf{{\emph{Metabolic:}}}}\{\{nl\}\}- Obesity\{\{nl\}\}- Insulin resistance (diabetes) increases risk of OA (through release of inflammatory mediators \& oxidative stress)} \tn 
% Row Count 39 (+ 15)
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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{Understand all about OA}} (cartilage breakdown):\{\{nl\}\}⏺ {\bf{{\emph{Presentations:}}}}\{\{nl\}\}- {\bf{Hip pain:}} deep achefekt in groin or buttock area; worse when weight-bearing; improve w/ rest\{\{nl\}\}- {\bf{Hip stiffness:}} especially in the morning or after prolonged inactivity\{\{nl\}\}- {\bf{Decreased ROM}}\{\{nl\}\}- {\bf{Cracking or popping}} sounds\{\{nl\}\}- {\bf{Weakness of hip muscles:}} affecting walking, stairs, etc\{\{nl\}\}⏺ {\bf{{\emph{Diagnosis:}}}}\{\{nl\}\}- (w/o imaging): +45 y.o AND have activity-related pain AND morning stiffness for 30+ min\{\{nl\}\}⏺ {\bf{{\emph{Management:}}}}\{\{nl\}\}- Local muscle strengthening, general aerobic fitness\{\{nl\}\}- Doing regular \& consistent exercise, though may initially cause pain/discomfort\{\{nl\}\}- Manual therapy alongside therapeutic exercise\{\{nl\}\}- {\bf{NO}} acupuncture} \tn 
% Row Count 16 (+ 16)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Referral patterns for trigger points in muscles of the buttock}}\{\{nl\}\}- {\bf{Gluteus medius:}} lateral hip, thigh, \& buttocks\{\{nl\}\}- {\bf{Gluteus maximus:}} posterior thigh \& lower leg\{\{nl\}\}- {\bf{Piriformis:}} down posterior thigh \& into calf\{\{nl\}\}- {\bf{Quadratus femoris:}} hip joint, groin, \& knee\{\{nl\}\}- {\bf{Obturator interns:}} hip joint \& groin} \tn 
% Row Count 23 (+ 7)
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Guidelines for the management of OA, especially hip OA}}\{\{nl\}\}- Hip is 2nd most common OA location\{\{nl\}\}- Therapeutic exercise \& weight management (if appropriate)\{\{nl\}\}- Provide information \& support\{\{nl\}\}- Exercise, little \& often\{\{nl\}\}- Manual therapy: massage, exercises, ROM \& strengthening\{\{nl\}\}- Hydrotherapy is beneficial} \tn 
% Row Count 30 (+ 7)
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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{Referral guidelines for imaging in a pt w/ suspected OA}}\{\{nl\}\}- Don't require imaging for diagnosis of OA: medicalHx \& examinations will suffice\{\{nl\}\}- Imaging findings don't always correlate well w/ the pt's Sx (particularly in early stages of OA)\{\{nl\}\}- No gold standard\{\{nl\}\}- Considered if OA severe, underlying condition or for monitoring\{\{nl\}\}- {\bf{Possible:}} X-ray, MRI, \& ultrasound} \tn 
% Row Count 8 (+ 8)
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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}}{Looks like hip OA from Hx and physical examination\{\{nl\}\}- Walking differently causing myofascial problems\{\{nl\}\}- Knee examination SHOULD HAVE been done((nl))- Hip OA management\{\{nl\}\}- imaging not necessary (no imaging for osteoarthritis unless daily activities are affected)} \tn 
% Row Count 6 (+ 6)
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\mymulticolumn{1}{x{17.67cm}}{KNOW REFERRAL PATTERNS FOR MYOFASCIAL TRIGGER POINTS - TRIVAIL AND SIMONS} \tn 
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