Activity 1

• Write 2-3 simple mechanical differential diagnoses (use the Dx template).

Sub- acute on chronic moderate bilateral metatarsal – tarsal osteoarthritis

complicated by suspected congestive heart failure

Sub-acute on chronic moderate bilateral dorsal foot mediated pain, suspected

cause; canal stenosis of L5-S1

Activity 2

• Perform an appropriate examination for a patient with a suspected simple

mechanical diagnosis.

– Including how do you differentiate (via history & examination) a low back
radiculopathy or ankle/foot pathology, from a more serious spinal canal
pathology - make a comparison table.

– Outline a complete management plan for your simple MSK diagnosis.

Differentiation low back radiculopathy or ankle/foot serious spinal canal

in history / pathology pathology
examination
Location - Localised pain - Neurogenic pain
- Pain is traceable characteristics
- Somatic pain characteristics - Pain increases on
- Neurogenic pain extension
characteristics - Pain originating
point and
traceable route
Onset - Can be onset by trauma, - Slow onset,
injury typically not
- Can be a fast or slow onset sudden
- Can be caused by
degeneration, less
linked to trauma
or injury
Duration - N/A - N/A
 Course - Pain worse on activity, - Pain constant with
relieved with rest activity / rest
- Can be absent in morning
Type - Burning sensation - Burning sensation
- Dull ache - Traceable pain
- Throbbing
- Traceable pain
Radiating - Traceable pattern - Traceable pattern
factors - Or localised to the foot - Central located
pain
Relieving - Lying - Flexion
factors - Extension of lumbar spine
- Reduction in weight bearing
of ankles
Aggravating - Flexion - extension
factors - Weight bearing of the ankles
Previous - N/A - N/A
episodes
Previous N/A N/A
treatment
Associated
symptoms
Systems review
Physical exam - Msk findings (somatic - Neurogenic
finding) findings
- Positive findings for nerve
root compromise
Orthopaedic - Positive SLR, slump, Valsalva - Positive kemps,
examination extension
Management plan

Sub- acute on chronic moderate bilateral metatarsal – tarsal osteoarthritis complicated by

suspected congestive heart failure

Phase Treatment Rehabilitation

1st phase; Patient education: reduction in - Substitution of
Inflammatory phase activities that cause excessive activities like
Weeks 0-2 pain (replace with activities that walking / jogging
encompass less joint stress), for aquarobics /
reduction in weight to allow less bike riding /
stress on body hydrotherapy
- Unweighted
- Passive ROM Mobilization
mobilisations exercises; ROM
- STW of the foot / ankle / exercises
calf
 - Manipulation of the hip /
knee / ankle / foot
- Transcutaneous
electrical nerve
stimulation
2nd phase; - thermotherapy - Functional
rebuilding phase - Passive ROM exercises;
Weeks 2-6 mobilisations incorporating
- STW of the foot / ankle / ADLs, using full
calf ROM
- Manipulation of the hip / - Weighted
knee / ankle / foot mobilization
- Transcutaneous exercises; ROM
electrical nerve exercises
stimulation
3rd phase; - thermotherapy - Balance and
reconstructive - Passive ROM proprioceptive
phase mobilisations exercises; Full
Week 6 onwards - STW of the foot / ankle / ROM and inclusion
calf of wobble board
- Manipulation of the hip / - Functional
knee / ankle / foot exercises;
- Transcutaneous incorporating
electrical nerve ADLs, using full
stimulation ROM
- Weighted
mobilization
exercises; ROM
exercises