Write the pathway that food would take from ingestion through the digestive tract. Your answer must include 20 structures. Ex: Structure, Structure, Structure, etc.

Pt is a 26 yo recreational runner who presents with an 3-week hx of R lateral ankle and foot discomfort.  Onset of R lateral foot and ankle occurred 3 weeks ago when running, coming off a curb and ‘landing funny’ on the R foot.  The patient denies swelling and completed the remainder of the run with mild soreness on the lateral side of the R ankle/foot. There was a noted increase in pain and stiffness of the foot the next morning but it did not prevent the patient from walking. The patient indicates a history of ‘a few’ ankle sprains when playing intramural basketball while in college that required a few days rest but the patient reports recovering ‘just fine’ from them without intervention.  Otherwise PMH is unremarkable.  The patient took 2 ibuprofen 2 or 3 times but it did not help so they stopped. Current symptoms: there is persistent low level pain (3/10) in the lateral ankle/foot region The patient presents to physical therapy via direct access as they would like to continue training for a 1/2 marathon that is in 8 weeks.   Generate 2-3 prioritized, differential hypotheses (at least 1 each from the lower leg/shin and the foot/ankle region) stating specifically the information that was listed that led you toward each hypothesis?

A 16 yo ♀ competitive volleyball player with a 2-yr h/o intermittent anterior R knee pain and swelling is referred to PT for evaluation and management.  6 wks ago, she had a fat pad debridement surgery and has been going to PT sessions since then at another PT clinic.  Each time she returns to volleyball, her pain and swelling returns.  The activities required for volleyball include running, cutting, jumping, and pivoting; each of these increases her pain.  During the 2 yr prior to surgery, her pain was in the medial aspect of her knee.  However since surgery, she experiences pain on both the medial and lateral sides of the knee.  In the last 4 weeks, she has been experiencing pain and swelling similar to what she had prior to surgery.  With either an increase in practice or game frequency, the anterior knee pain increases to an 8/10 from a baseline of 1/10 on VAS.  With 2-3 days rest, her pain and swelling are eliminated.  She has tried multiple interventions, e.g. ice, heat, compression, OTC NSAIDs, which provide short duration symptomatic relief and are only effective if she is not playing volleyball.  Although she has been in ‘formal’ PT for the last 6 wks, her sx have not been reduced.  Her goal is to return to volleyball symptom-free, now that the season has started.  Her MD (ortho) has not placed any restrictions on her activity.   Generate 3 differential hypotheses stating specifically the information that was listed in the subjective that led you toward this hypothesis?

A 16 yo ♀ competitive volleyball player with a 2-yr h/o intermittent anterior R knee pain and swelling is referred to PT for evaluation and management.  6 wks ago, she had a fat pad debridement surgery and has been going to PT sessions since then at another PT clinic.  Each time she returns to volleyball, her pain and swelling returns.  The activities required for volleyball include running, cutting, jumping, and pivoting; each of these increases her pain.  During the 2 yr prior to surgery, her pain was in the medial aspect of her knee.  However since surgery, she experiences pain on both the medial and lateral sides of the knee.  In the last 4 weeks, she has been experiencing pain and swelling similar to what she had prior to surgery.  With either an increase in practice or game frequency, the anterior knee pain increases to an 8/10 from a baseline of 1/10 on VAS.  With 2-3 days rest, her pain and swelling are eliminated.  She has tried multiple interventions, e.g. ice, heat, compression, OTC NSAIDs, which provide short duration symptomatic relief and are only effective if she is not playing volleyball.  Although she has been in ‘formal’ PT for the last 6 wks, her sx have not been reduced.  Her goal is to return to volleyball symptom-free, now that the season has started.  Her MD (ortho) has not placed any restrictions on her activity.   What criteria would you consider prior to allowing her to return to sport?  Why?

A 55 yo female presents with LBP.  She has been an active runner since college.  Occasionally, she has participated in aerobic classes.  Her hx is unremarkable.  She has 3 grown children and had no c/o back pain related to her pregnancies. Current sx:  intermittent periods of pain extending from mid-lumbar spine, through the R buttock and posterior thigh.  The pain begins 15 min into her running and progresses to an 8/10 by 25-30 min.  She also c/o increased stiffness after sitting > 1 hour, standing > 15 min, as well as when waking in the morning and getting out of bed.  She is a middle school teacher and track coach for a girl’s HS team. Key Findings: Lordotic posture Movement testing: Forward bending of the spine increased tension in low back Repeated backward bending and prone press-ups increase buttock pain Side bending is decreased 25% with some discomfort with overpressure into R side bending Ms Length: tight low back, B hip flexors and TFL Ms Performance: lower abdominals 4/5 What is your initial hypothesis and how would you r/i or r/o your hypothesis?

A. _______ B. _______

A 16 yo ♀ competitive volleyball player with a 2-yr h/o intermittent anterior R knee pain and swelling is referred to PT for evaluation and management.  6 wks ago, she had a fat pad debridement surgery and has been going to PT sessions since then at another PT clinic.  Each time she returns to volleyball, her pain and swelling returns.  The activities required for volleyball include running, cutting, jumping, and pivoting; each of these increases her pain.  During the 2 yr prior to surgery, her pain was in the medial aspect of her knee.  However since surgery, she experiences pain on both the medial and lateral sides of the knee.  In the last 4 weeks, she has been experiencing pain and swelling similar to what she had prior to surgery.  With either an increase in practice or game frequency, the anterior knee pain increases to an 8/10 from a baseline of 1/10 on VAS.  With 2-3 days rest, her pain and swelling are eliminated.  She has tried multiple interventions, e.g. ice, heat, compression, OTC NSAIDs, which provide short duration symptomatic relief and are only effective if she is not playing volleyball.  Although she has been in ‘formal’ PT for the last 6 wks, her sx have not been reduced.  Her goal is to return to volleyball symptom-free, now that the season has started.  Her MD (ortho) has not placed any restrictions on her activity.   For each hypothesis, please list the objective findings (during complete examination) that you would perform to confirm or refute your diagnosis. Please briefly explain the findings that you would expect for these tests and why.

Pt is a 26 yo recreational runner who presents with an 3-week hx of R lateral ankle and foot discomfort.  Onset of R lateral foot and ankle occurred 3 weeks ago when running, coming off a curb and ‘landing funny’ on the R foot.  The patient denies swelling and completed the remainder of the run with mild soreness on the lateral side of the R ankle/foot. There was a noted increase in pain and stiffness of the foot the next morning but it did not prevent the patient from walking. The patient indicates a history of ‘a few’ ankle sprains when playing intramural basketball while in college that required a few days rest but the patient reports recovering ‘just fine’ from them without intervention.  Otherwise PMH is unremarkable.  The patient took 2 ibuprofen 2 or 3 times but it did not help so they stopped. Current symptoms: there is persistent low level pain (3/10) in the lateral ankle/foot region The patient presents to physical therapy via direct access as they would like to continue training for a 1/2 marathon that is in 8 weeks.   Describe your plan of care and key interventions to address the impairments, activity limitations, and patient goals identified.

A patient presents to the clinic with complaints of right sided shoulder pain and weakness.   The patient states the mechanism as “pitching on his baseball team”.  In the Review Of Systems (ROS) form he selects dizziness and headaches, and under past medical history he states that he had a concussion the prior fall while playing football. During subjective examination the patient denies any focal weakness until ½ way thru the season (3 weeks ago) when he was asked to pitch 3 days in a week.  The pain started the next day, and currently has mild pain at rest in the shoulder and scapula region.   The patient states that he was concussed when hit on right side of head, while playing middle linebacker for the football team, and missed one game due to cervical pain, headaches, right arm weakness and dizziness. Then was able to play in the playoffs after being cleared by the team MD.  The patient denies any focal pain in the cervical spine at this time unless he looks over right shoulder quickly and states that the dizziness only occurs very infrequently if he changes head position very quickly (with looking behind him when pitching and ball is hit by him).   The patient’s current symptoms include weakness that occurs when he is pitching for 2-3 innings, stating his velocity is down 5 miles an hour, and he has reduced command of his pitches, stating “I don’t know where they are going”.   At times after the pain occurs, he feels like he can’t feel the ball as well when throwing and has mild tingling in 4th and 5th digits.   The patient states mild aching and weakness in the posterior shoulder and scapular area after his last 4-5 pitching episodes, but that it hasn’t limited him from playing at this time.   At times he states that occasionally he will get “cramping” in the shoulder region. 

Given the duration of this injury, what psychosocial factors would you find important to identify for this patient and why? What measures would you use to assess?