Khaled Mokhtar Hasan
20171742
Case 4 :
1-Goodman screening :
Personal History :
 54 year-old female
Past history :
 History of falling from the first floor
 Chronic low back pain
 History of uterine bleeding
 History of uterine discharge
 Right hip joint pain
Risk factors assessment :
 Female
 Age (54)
 Menopause
 Uterine bleeding & Vaginal discharges
Clinical Presentation :
 Chroinc low back pain that appears with effort and hip joint
pain
Associated Signs and Symptoms :
 Uterine bleeding
 Vaginal discharges
2-Red flags :
 Vaginal discharges (may be because of urinary tract infection)
 Uterine bleeding (may be because of uterine tumor)
 Persistent low back pain and hip joint even after the long
period of physical therapy
3-FUBs :
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Do you use any medications ?
Show me exactly where that pain is located ?
What does that pain feel like ?
When you feel that pain , what makes it feel better ?
When you feel that pain , how long does it last ?
How strong is that pain on a scale from 1 to 10 ?
4-Further assessment :
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Vital signs (RR,HR,O2%,Temperature)
Assessing the effect of flexion & extension on the back pain
Slump test
SLR : compresion on the roots of sciatic nerve
Extension Quadrant test : examining intervertbral foramina
narrowing
Patric test : hip & SIJ
Hip thrust
Sacral thrust (with caution)
Hip ROM assessment
5-Diffrient possibilities :
 The back pain could be disc herniation or mechanical pain due
to malunion after a spine fracture due to the fall or referred
pain from a problem in the uterine
- We need to refer her to an obstetrician to role out the uterine
problems such as tumor.
- We need to role out the disc herniation and the malunion by
asking for a MRI.
 The hip joint pain could be a problem in the hip joint itself or a
referred pain eg : SIJ dysfunction
- hip inspection and palpation , hip ROM , FABER test , hip thrust ,
sacral thrust (with caution) , compresion test , distraction test ,
ganslen test.
6-My decision :
Is to refer her to an obstetrician to role out any uterine problems
or tumors and any UTI Because of the uterine bleeding and the
vaginal discharges and the persistence of pain even after a long
duration of physical therapy.