elderly patient

[Netty]

What would you advise and what would you do in this situation?

Had a 75 year old male patient, very frail, whom was in considerable pain in the lower back, with pain going down the right leg. He was very unsteady on his feet and could hardly get on the couch. Just about got him to lie prone but certainly couldnt then get him to move onto his side or supine. How would you go about assessing him? As it was difficult to assess him standing as well as lying!

Thanks

Netty

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[okphysio]

Hi Netty,
have you tried to assess him in a seated position. He can rest his arms and support his upper body on a table so that you can palpate from behind. You can also do modified slump and hip ROM/ms assessment in this position. Taking his age into coinsideration, i would suspect that he has some degree of stenosis so any postion that puts his spine in relative extension will be provocative.
hope this helps

[Netty]

I will try to assess the patient in a seated position.

Would you also suggest to this patient then that they should return to their GP and request a MRI scan? so as to get a more accurate diagnosis?

What would you suggest I could do in the meanwhile to help this patient?

Thanks

Netty

[okphysio]

Hi Netty,
you could refer back to the GP and have investigations. However, you really need to correlate any ivestigation findings with his clinical diagnosis. If you are thourough with your cinical assessment, then it should be enough to get a good clincal picture of his condition. But just remember that with such a patient i.e. elderly and with chronic history, his overall presentation will most likely be a combination of various contributing factors such as foraminal narrowing, stenosis, general disc degen etc....so don;t just look for one thing.
Without actually assessing him myself, it is hard to say what he would benefit from. In general, improvement of intersegmental mobility through passive or active strategies will help the situation. Have a look at areas such as his hip flexibility and movement strategies that he tends to use to get around.
Hope this gives you some ideas.
let me know how you go.