Cervical cord compression secondary to ossification of the posterior longitudinal ligament.
METHODS
Resident's case problem.


BACKGROUND
A 52-year-old Chinese male with a 10-year history of gradually worsening right hip stiffness, weakness, and pain was referred to physical therapy by his orthopedist, who made a diagnosis of developmental dysplasia of the right hip, with possible Legg-Calve-Perthes disease. The patient reported multiple falls over the last several years and a gradual onset of low back pain with an onset of "electricity" down both legs. The patient also reported mild numbness in both forearms and the right hand over the previous several months. This resident's case problem illustrates how a physical therapist recognized the presence of an atypical musculoskeletal pathology through the use of hypothesis-driven clinical reasoning and detailed physical examination.


METHODS
Examination of the patient's lumbar and cervical spine and hips revealed joint dysfunctions. Neurological testing revealed hyperreflexia. Special testing revealed lower extremity clonus with a positive Babinski sign with gait disturbances. The patient was referred back to his primary physician and then to a neurologist and neurosurgeon. An MRI revealed cervical myelopathy due to ossification of the posterior longitudinal ligament from C3/C4 to C5/C6. The patient then underwent a C3 through C7 laminectomy.


CONCLUSIONS
It is always imperative that sound clinical reasoning be used when performing physical therapy evaluations, regardless of the referral status of the patient. Patients with nonmusculoskeletal pathology may seek physical therapy services and it is the physical therapist's responsibility to complete a thorough examination and refer to specialists when appropriate.
Sasaki
Monica
M
California Pacific Medical Center, Department of Physical Medicine and Rehabilitation, 2360 Clay Street, San Francisco, CA 94115, USA. mjsasaki@comcast.net
D002681:China / Q000208:ethnology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000175:diagnosis / Q000503:physiopathology*; D026761:Physical Therapy Specialty; D011859:Radiography; D012017:Referral and Consultation; D013117:Spinal Cord Compression / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014481:United States