Volume 9:5

Chronic Post-Surgical Pain as a Limiting Factor of Functional Improvement in a Patient with Tibial Adamantinoma: A Case Report

Kaitlyn Timm ATC, LAT

Clarke University, Waupun, WI

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Study Design: Single-subject case design.

Background: Adamantinoma is a rare form of bone cancer that generally presents as a tumor in the lower extremity. The primary treatment for adamantinoma involves surgical intervention which may include limb amputation or resection of the tumor with autograft or allograft reconstruction. The purpose of this case report is threefold; to describe the occurrence of a rare bone tumor and the surgical procedure used to treat it, to present the unique post-surgical signs and symptoms that the health care providers may encounter following resection of an adamantinoma, and to heighten awareness of the need for pain control therapies in the acute and post-acute stages following surgical resection of an adamantinoma.

Case Description: 54-year-old female referred to physical therapy following surgical resection of a tibial adamantinoma with 10-centimeter allograft reconstruction. At initial evaluation, the patient presented with severe right leg and knee pain during weight bearing activity as well as gait deviations.

Outcomes: Four months following initiation of therapy (19 months post-operative) the patient required a single lofstrand crutch to ambulate, rated pain consistently at 5/10, she briefly tolerated single leg stance on her right lower extremity.

Conclusion: Post-surgical pain that develops into chronic pain represents a major, and often unrecognized, clinical problem. After 4 months of physical therapy this patient made minimal progress and her pain persisted. A possible cause of the patient’s lack of progress could be the absence of early physical therapy interventions to address her pain.


Evaluation of Asymmetry in Lower Limbs of Roller Derby Athletes

Erica Cheramie, SPT; Alex Bonner, SPT; Ashley Henderson, SPT; Brittany Battle, SPT; Ashley Eye, SPT; Jennifer Bunn, PhD, EP-C

Campbell University, Department of Physical Therapy, Advanced Interdisciplinary Movements Sciences Laboratory, Buies Creek, NC, USA

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Study Design: Prospective, observational.

Objectives: The purpose of this study was to evaluate bilateral discrepancies in lower limb strength and flexibility in female roller derby athletes.

Background: Asymmetries in muscle strength have been documented in a variety of lower extremity sports including soccer, football, track and field, and speed skating. These asymmetries are thought to increase the risk of injury and decrease performance. In the sport of roller derby, players skate primarily in a counterclockwise direction. This movement pattern may put players at risk of developing asymmetries of the lower extremities.

Methods and Measures: Fourteen female roller derby athletes (36.6 ± 9.0 years) participated in the study. Hip flexor and extensor extensibility was measured bilaterally by a straight leg raise and the Thomas test. Strength of the hip flexors, hip extensors, knee flexors, and knee extensors were measured using handheld dynamometry.

Results: Significant bilateral differences were observed in hip flexor strength (right 113.3 ± 15.4 N, left 103.5 ± 12.9 N, p =. 023), but no differences were shown for any other strength measure (p > .05). There was a significant difference in muscle extensibility for the Thomas test (right 5.7 ± 1.0 ̊, left limb 8.6 ± 2.5 ̊, p = .013), but not the straight leg raise (p > .05).

Conclusion: This study observed the potential for asymmetries in muscle strength and flexibility in lower limbs of roller derby athletes. Asymmetries were observed in both muscular extensibility and hip flexor strength. This is the first study of its kind to observe muscular asymmetries specific to roller derby athletes. Due to the repetitive, unidirectional nature of roller derby, identifying risk factors in this community can aid in educating participants on the significance of injury prevention and safe training practices, and lead to better return to play protocols post-injury. 


Physical Therapy Management of a Patient Post Burn Injury Complicated by Alcohol Withdrawal Syndrome: A Case Report. 

Ashton Duncan, SPT; Kate Alexander, PT; Deborah Wendland PT, DPT, PhD, CPed 

Mercer University, Atlanta, GA

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Background & Purpose: Early intervention techniques proposed in burn literature often do not include best practice techniques modified to account for common co-morbidities in these patients, such as alcohol withdrawal syndrome (AWS). The purpose of this case report is to present intervention techniques that address common impairments associated with a burn injury while addressing medical complications in the acute care setting.

Case Description: This patient is a 56-year old male who sustained a burn while smoking and drinking moonshine. Upon hospital admission and following surgery, the patient began experiencing AWS in addition to burn sequelae including contractures, decreased mobility, and decreased cognition. Interventions included standard physical therapy management techniques and techniques that addressed factors compounded by AWS.

Outcomes: The AM-PAC 6- clicks was used to assess the patient’s level of ability while in acute care. During his admission, the patient’s overall functional mobility ranged from 0% ability to 45% ability and improved such that inpatient rehabilitation requirements were met.

Outcomes: Despite medical complications, the main goals of physical therapy for patients with burns should remain the same (wound management, contracture prevention and increase of functional mobility). But, interventions should be modified to meet the individual’s needs related to the complications present.


Individualized exercise program for lower back pain in a person with moderately advanced multiple sclerosis: A case study.

Joshua Lathrop, SPT; Grant Poston, SPT; Breanna Reynolds, PT, DPT, FAAOMPT; Melissa Peterson, PT, PhD, GCS; Brenda Pratt, PT, DSc, PTCS

Bradley University Department of Physical Therapy, Peoria, IL

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Study Design: Case study.

Background: Multiple Sclerosis (MS) is a neurological condition resulting in a number of clinical manifestations including pain. Specifically, low back pain (LBP) of musculoskeletal origin has been reported to occur in 10-20% of individuals with MS. Limited research exists to guide the clinician in the management and treatment of LBP in the MS population. The purpose of this case study is to describe an individualized, orthopedic, evidenced-based approach used to treat an individual with significant disability due to MS and a primary complaint of chronic LBP.

Case Description: The participant was a 48-year-old male with a diagnosis of relapsing-remitting MS (Expanded Disability Status Scale (EDSS): 6.0), primary complaint of chronic LBP, and patho-anatomical diagnosis of spinal stenosis. The participant elected to undergo an 8-week individualized exercise program with a primary focus of improving upon his LBP symptoms. Interventions included a four-fold orthopedic, evidenced- based approach consisting of patient education, manual therapy, exercise and aerobic exercise.

Outcomes: The participant demonstrated improvements in all physical outcome measures consisting of: Timed Up and Go, 30-second chair stand test, Berg Balance Scale, and the 6- minute walk. Statistically significant changes were observed in all measures but the 6-minute walk.

Conclusion: A program with a primary focus of spinal stabilization exercises in modified positions and participant education appeared to be the most effective intervention for this individual. Future research examining the effectiveness of physical therapy interventions directed at improving LBP in the MS population is needed.