Lorma Colleges

Carlatan, City of San Fernando, La Union

College of Physical and Respiratory Therapy

CLINICAL EDUCATION :
INITIAL EVALUATION FOR
HIP OSTEOARTHRITIS

Submitted by:
Flores, Paul John
Floresca, Denise Dawn
Garcia, Jennie Ross
Gurtiza, Joanna Eden

Submitted to:
Theresa Rose Combalicer

Pathophysiology of OA:

1. BUILD-UP
The articular cartilage starts to show signs of weakening due to a lifetime of use
2. CARTILAGE SWELLING
Weight bearing activity causes the weakened cartilage to start swelling
(pain on activity, relieved by rest)
3. JOINT NARROWING
Swollen, weakened cartilage starts to wear causing the joint space to decrease
(stiffness pain)
4. BREAKDOWN
Continued wearing away of the articular cartilage leads to particles within the joint and an
irregular joint surface
(swelling joint clicking)
5. COMPENSATION
As the joint become more painful, we use it differently. This leads to new bone growth on the
joint margin (marginal osteophytes)
(limited range of motion)

INITIAL EVALUATION
GROUP 4
Patients Name:

F.B

Age:

50 y/o

Sex:

Male

Address:

San Fernando, La Union

Civil Status:

Married

Handedness:

(R)

Occupation:

Farmer

Religion:

Roman Catholic

Referring Dr.:

Dr. G

Referring Unit:

OPD

Rehab Dr.:

Dr. P

Date of Referral:

September 6,2016

Date of Consultation: September 6, 2016

Date of Eval:

September 6, 2016

Diagnosis:

(R) hip OA

S:
C/C: Sumasakit tuwing umaga at hapon yung kanang hita ko hanggang tuhod.Lumalala
kapag umaga at hapon na hindi tumatagal ng isang oras
C/O: Radiating constant pain extended down from the front of his (R) thigh (R) knee c
a PS of 6/10 (using VAS). Pt. noted that pain is felt especially during a.m and @ p.m in
1h.
HPI:

Present condition started 1 yr. ago prior to PTIE when pt. felt radiating constant

pain extended down from the front of his (R) thigh (R) knee while he was planting rice in
the field. He relieved the pain by NWB position like lying down on his back & taking
Paracetamol 325 mg(q6h) for pain and ibuprofen 200 mg (q6h) for swelling. Pt has max
difficulty in performing functional skills such as prolonged walking, sitting standing from
chair, & climbing stairs. Pt has mod difficultly in performing ADLs such as donning & doffing
of pants & socks, urinating & defecating.
PMHx: Pt didnt have any injury before or any previous history of hospitalization, (+) HTN,
(-) DM, (-) Surgical Procedures. Unremarkable

PSHx: Pt is a farmer & work involves squatting, stooping down, & planting rice on the field
for ~7 hrs 5 times/wk. Pt lives c his wife & son (20 y/o) in a bungalow house, bedroom
comfort room:7 steps, kitchen living room:5 steps, living room main door:4 steps,&
main door rice field:50 steps. He is a social smoker (6sticks/day) & an occasional
alcoholic beverage drinker. Other than planting rice, he also help his wife in making baskets
which involves prolong sitting.
Goal:

"Gusto ko mawala na yung sakit para magawa ko na ng maigi ang trabaho ko".

VS:

BP= 130/90mmHg

O:

PR= 80 bpm
RR= 18 cpm
To= 37oC
OI:

Manner of arrival: Ambulatory c assistive device

Mental status: Alert/ Coherent/ Cooperative
Body type: Ectomorph
Trophic skin changes: (+) erythema on hip
Atrophy: (+) hamstring m & quads m
Postural deviation: (+) (see Postural analysis)
Attachment: (-)

PALPATION:
Thermal assessment: All body parts are normotermic except for a hyperthermic
on inguinal area.
Tone assessment: Normotonic on hip
Tenderness: (+) gr. II tenderness on groin area c dull, aching pain when
palpated
Muscle spasm: (+) d/t muscle guarding
Swelling: (+) on hip
Tightness: (+) on hip jt.
Edema (grade & type): (-)

ROM:
Findings: Motions of (B) UE/LE, neck and trunk were assessed actively, and are
WNL except for the ff:
Difference
AROM

PROM

10 o

7o

Motions
hip

AROM
0 20o

PROM
0 23o

(N)
0 30o

Endfeels
Empty

extension
hip flexion
hip internal

0-50 o
0 38o

0-56 o
0 40o

0-120 o
0 45o

Empty
Empty

70 o
7o

64 o
5o

rotation
hip

0-30 o

0-33 o

0-45 o

Empty

15 o

12 o

rotation
hip

0 30o

0 35o

0 45o

Empty

15 o

10 o

abduction
hip

0 18o

0 20o

0 30o

Empty

12 o

10 o

external

adduction
Sig: LOM 2o to pain & formation of marginal osteophytes
MMT:
Findings: All major (m) of (B) UE/LE were grossly graded 5/5 except for:
Muscles
hip extensors
hip flexors
hip abductors
hip adductors
hip internal rotators
hip external rotators

Grade
3/5
3/5
3+/5
4/5
4/5
3/5

Sig: (m) weakness 2o to inactivity

ST:
(+) Faber test
(+) Trendelenburgs sign
(-) Obers Test

Sig: 2o to pain on hip

NEUROLOGIC EVALUATION:
Sensory Testing
Devices Used: Pin for pain, brush for light touch and thumb for deep P
Findings: 100% Intact sensation
Sig: Intact sensory pathway
DTR:

(L)

(R)

++

++
++

++

++
++

++
++

++

++

Legend: 0

areflexia

hyporeflexia

++

normoreflexia

+++ hyperreflexia
++++ clonus

Findings: Normoreflexive on (B) UE/LE

Sig: Intact reflex arc
ANTHROPOMETRIC MEASUREMENT:
Leg Length Measurement: Why 1 cm???
Landmark
(L)
TLLM
ASIS to medial malleolus 85 cm
ALLM
T10 to medial malleolus
95cm
o
Sig: TLL discrepancy 2 to marginal osteophytes
ALL discrepancy 2o to (m) immobility

(R)
88cm
96cm

Diff
1cm
1cm

Limb Girth Measurement:

Landmark
3
2
1
Patella

L
54cm
48cm
45cm
42cm

R
52cm
46cm
42cm
42cm

Difference
2cm
2cm
3cm
0

Sig: 2o to muscle atrophy

PA:
Findings:
Anterior View:
Sh. Is higher than (L) sh.
lat. curvature
(L) iliac crest is higher than the iliac crest
hip slightly adducted
knee is lower than (L) knee
genu valgum
foot pronation
Posterior View:
Sh. is higher than (L) sh.
scapular elevation (L) iliac crest is higher than the iliac crest
Lateral View:
head forward
sh. Elevation

GA:
Stance Phase
IC
LR
MS
TS
Swing Phase

(L)

(R)
+
+
+
+

_
_
_
_

(L)

(R)

IS
MS
TS

+
+
+

Decrease
Decrease
Decrease

Sig: Antalgic gait on side of the body 2 o to pain

FA:
Pt has max difficulty in performing functional skills such as prolonged walking,
sitting to standing from chair, & climbing stairs. Pt has mod difficultly in performing
ADLs such as donning and doffing of pants & socks, urinating & defecating.

A:
.
PT Impression: Pt is a 50 y/o male who works as a farmer has a difficulty in
performing functional skills such as walking, climbing stairs, and rising from chair. Pt has
difficulty in performing ADLs such as donning and doffing of pants & socks, urinating &
defecating d/t pain & stiffness on hip 2o hip OA

Procedural Intervention: Compensatory Intervention

Rehabilitation Potential: Good d/t intermittent s/sx
Prognosis: Pt has a good prognosis that complies with PT Mx base on rehabilitation
potential and family support.

Problem list
1. Pain and tenderness

LTG (24tx session)

Pt will demonstrate proper

STG (12 tx session)

Pt. will report a pain on

on his R hip with PS

body mechanics & observe

hip from 6/10-4/10 p 3

6/10

proper posture to the

days of tx

occurrence of pain p 3 wks

Pt will achieve near (N)

Pt will increase ROM by

hip ext.,flex., int. rot,

ROM on hip extension,

3o increments on hip

ext. rot,abduction, &

internal rotation, abduction,

extension, internal

2. Limited ROM on

adduction.

& adduction within 5 wks

rotation, abduction, &

adduction p every tx

Pt will achieve optimum (m)

session
Pt will increase (m)

hip extensors

strength on (R) hip

strength by 5o increments

&flexors, internal&

extensors,flexors, int.

on (R) hip extension,

external rotators,

rotators, ext

internal rotation, &

abductors&adductors

rotators,abductors &

abduction p every tx

muscles

adductors within 5wks

session

Pt. will demonstrate (N)

Pt will report a diff. in

in performing

functional act. w/n 5 wks of

performing functional

functional activities

tx.

activity within 3 wks of tx

3. (m) weakness on

4. Pt. has max difficulty

such as walking,

session

climbing stairs, and

sitting
5. Pt has mod difficulty

Patient will easily perform

Patient will easily perform

in performing ADLs

ADLs(bathing,eating,doffing

ADLs(donning and

such as donning and

and donning) c no difficulty

doffing of pants & socks,

doffing of pants &

w/n 4 wks of tx.

urinating & defecating)

socks, urinating &

defecating
6. (+) Postural deviation

mod min difficulty w/n

Pt will achieve (N) posture

2 wks of tx.
Pt will report a decrease

& proper body mechanics

postural deviations & m

within 5 wks.

guarding within 3 wks of

tx.

P:
PT Mx:
Pt will be treated as an OPD for 24 tx session
1. US x 1.5 W/cm2 x 5x2x/wk on hip to pain and promote healing
2. PREsx2x/wk on LE c 1lb AWx10repsx1set AP to increase m strength
3. Aquatic ex. x20 2x/wk for jt mobilization

4. Gait training inside // bars c obstacles x 5 rounds

5. Mini squat x5SHx10reps
Precaution:
1. BP