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Pt is a 26 yo recreational runner who presents with an 3-week hx of R lateral ankle and foot discomfort.  Onset of R lateral foot and ankle occurred 3 weeks ago when running, coming off a curb and ‘landing funny’ on the R foot.  The patient denies swelling and completed the remainder of the run with mild soreness on the lateral side of the R ankle/foot. There was a noted increase in pain and stiffness of the foot the next morning but it did not prevent the patient from walking. The patient indicates a history of ‘a few’ ankle sprains when playing intramural basketball while in college that required a few days rest but the patient reports recovering ‘just fine’ from them without intervention.  Otherwise PMH is unremarkable.  The patient took 2 ibuprofen 2 or 3 times but it did not help so they stopped. Current symptoms: there is persistent low level pain (3/10) in the lateral ankle/foot region The patient presents to physical therapy via direct access as they would like to continue training for a 1/2 marathon that is in 8 weeks.   Generate 2-3 prioritized, differential hypotheses (at least 1 each from the lower leg/shin and the foot/ankle region) stating specifically the information that was listed that led you toward each hypothesis?

A. _______ B. _______

What would the key parts of your intervention include?

Given the duration of this injury, what psychosocial factors would you find important to identify for this patient and why? What measures would you use to assess?

From a Therapeutic Neuroscience Education perspective, please give 1-2 interventions that could be provided to the patient in initial evaluation to address his current status in the Fear Avoidance Model. Additionally, please explain why these interventions were chosen. 

For each hypothesis, please list the objective findings (during complete examination) that you would perform to confirm or refute your diagnosis. Please briefly explain the findings that you would expect for these tests and why.

Generate 2-3 differential hypothesis stating specifically the information that was listed in the subjective that led you toward this hypothesis?

A 56 yo female software analyst presents with a 7-week h/o left-sided neck pain that radiates down her posterior arm to her left elbow.  She denies trauma or any change in activity that is related to the onset. Radiograph shows degenerative changes at C6-7, C7-T1 greater than C4-5 with osteophytes at C6-7 (Refer to below image).   The patient had a 1-week trial of steroids that resulted in short-term relief of symptoms.  Unfortunately, the symptoms returned 1-week after she completed the steroid trial.   Her PMH is unremarkable. The patient rates her pain at 4/10 at best and 10/10 at worst.  The quality of the pain is sharp or pinching.  It worsens with any sitting or standing activity including driving, as well as overhead reaching.  The pain is lessened by lying in supine or sidelying.  Her current exercise regime is treadmill walking 5 times a week.  She continues this routine but with symptoms. Her Neck Disability Index score is 52%.  She reports functioning at 60% of normal function. The following are her physical exam findings: Posture:   mild protracted shoulders, moderate forward head, moderate thoracic kyphosis Shoulder A/PROM:  WNL with overpressure; no reproduction of sx

What outcome measures would you use to assess progress with PT and readiness for discharge?

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