So a quick updated should we consider referring this lady to physiotherapy or not? L We should consider referring this patient to physiotherapy, as it could be a valuable management option, especially for improving muscle strength and spinal stability. However, it’s essential to ensure there are no red flags and that she is medically stable before proceeding. Gandhi et al. (n.d.) highlighted positive outcomes of physiotherapy in managing wedge compression fractures of the L1 vertebra. Moreover, Kato et al. (2022) identified abdominal muscle weakness as a significant risk factor for future osteoporotic vertebral fractures in middle-aged and older women. Resources https://lnkd.in/ecamXHfi. https://lnkd.in/enFv8Tkw
A few weeks ago, I met a patient with a case that really stood out. She is a 38-year-old woman with ongoing mid and lower back pain. The pain has been there for four years and started after she had several surgeries for Pseudomyxoma Peritonei since 2018, a rare type of cancer. She didn’t have any injuries or falls. While she doesn’t have pain at night, she does experience night sweats, but hasn’t lost weight or her appetite. She works at a café, doesn’t smoke or drink, and is taking a medication with penicillin, a steroid cream for alopecia, and oestrogen tablets. Her back pain is worse in the mornings and with activities throughout the day. The pain at night seems to depend on her position. She feels more pain when bending or standing, but lying flat on her stomach or extending her back relieves it. During the consultation, she mentioned she had lost height, saying she used to be the same height as her sister, but now she’s shorter. Losing height can sometimes suggest osteoporosis or a spinal fracture, which is usually seen in older people. On examination, she had full range of motion in her back, but bending to the side and rotating caused pain. Extension, on the other hand, was less painful. Neurological checks were normal, but she had tenderness in her spine from T8 to L3, weak abdominal muscles, and noticeable lumbar lordosis. Her recent blood tests were normal. Given her symptoms, we decided to do a thoracic spine X-ray to check for fractures. The results showed wedge fractures in the T9 and T10 vertebrae—something uncommon for her age. Pseudomyxoma Peritonei, the rare cancer she had, usually starts in the appendix but can also affect the bowel, ovaries, or bladder. In her case, it began in her ovaries, leading to the removal of both ovaries. After discussing the case with a GP colleague, we agreed to refer her back to her oncologist and obstetrics and gynaecology team. We also arranged for a DEXA scan to check her bone density, with the plan to refer her to the osteoporosis clinic to start treatment if needed. This case highlights the importance of considering all factors when managing back pain, especially in patients with a complex medical history. Resources https://lnkd.in/erYBgYZF https://lnkd.in/eYgx4wKM https://lnkd.in/ehFGYzak