Case PRESENTATION ON ANKYLOSING Spondylitis

2. CONTENT
 Demographic Data
 On Observation
 On Palpation
 On Examination
 Special Test
 Physiotherapy management
 Conclusion

3.  Name -Y
 Age -35
 Sex - Male
 Occupation- CRPF
 Hosp. I.D -75/Gen/22

4. CHIEF COMPLAIN
 Severe Pain at the back patient
complaining that he cannot able to walk
straight and he not able to bend the hip,
cannot able to bear weight ,during
bending he feeling much pain at the back
with stiffness specially in the morning it
lasts for more then 25 min, buttock pain is
also there ,he cant even get up from bed
and rolling on the bed .

5. HISTORY OF PRESENT
ILLNESS
 Before 2 years he had fall in bathroom
,got pain at back , he went to orthopedic
to take analgesics medicine than he
recovered little bit but pain is not
subsides totally. Gradually it increased
day by day then he came to DDRC for
physiotherapy treatment .
• Drug history –taking analgesics for so
long
• Professional history -CRPF
• Past history –no medical history

6. Contd.
 NIGHT PAIN- It increse at winter night
 Personal History
Cigarettes – 2/day
Alcoholic - occasionally
 Socio-economic History – Good
 Family History- no family history

7. PAIN HISTORY
 Mechanism of injury – fall in bathroom
 Onset of injury – chronic
 Location of pain – dull at lower back
 Severity of pain - VAS -8[intense,
Horrible ]
 Aggravating factor – weight lifting ,
stair climbing
 relieving factor – resting,
hot pack

8. ON OBSERVATION
 General Condition - poor
 Body alignment – lean forward
 Muscle wasting -no
 Posture- bad
 Deformity - kyphosis
 Gait- decrease range of motion of hip
and knee
 Bandage - spinal brace

9. ON PALPATION
 Tenderness :- over T8,T9, L2,L3,L4
Grade 2
: Patient winces on pressure &
withdraws
 Temperature variation of skin- 38’C
 Spasm -present
 Swelling- mild

10. ON EXAMINATION
 Vital signs –bp- 128/65 mm/hg
HR-15-18 beat/ min
temp.-39’C
 Dermatome & myotome – normal
 Muscle girth – normal
 Limb length discripency- tru limb length

11. RANGE OF MOVEMENT
Movement JOINT
Cervical Lumbar HIP
Spine
R L R L
Flexion
Extension
Lateral
rotation
Medial
rotation
Adduction
Abduction
0-40 0-5 0-80 0-75
0-10 0 0-16 0-16
0-20 0 0-30 0-30
35-0 35-0
0-35 35-0

12. SPECIAL TESTS
 Schober test :- Positive
 Faber test:- Positive
 Gaenslen test
 Straight leg raising :-60-70 (left & right )
 Pump handle test :-Positive
 Respiratory examination

14. Contd.
 Investigation-Ankylosing Spondylitis
Differential Diagnosis –spinal fracture
spinal cord compressio
Spondylitis
Spondylolisthesis
osteoarthritis

15. PHYSIOTHERAPY TREATMENT
Short term goals
• To decrease pain
• To Improve body functions
• Increase muscle strength
• Increase ROM
Long term goals
• To control pain
• Improve general Function
• Activity of daily living
• Quality of life

16. Contd.
Electrotherapy
 SWD.UST
 MWD
Exercise therapy
 stretching
 Strengthening
 Bridging
 Balancing
 Gait training
 Increase range of motion
 Breathing exercises

17. Contd.

19. CONCLUSION
 Ankylosing spondylitis is associated with
increased risk for vascular mortality. The most
prevalent quality of life concerns included
stiffness (90%), pain , fatigue , sleep
problems, appearance future outcome, and
side effects of drugs . This follow up study
could be confirmed improvement of spinal
mobility when AS patients are treated with a
rehabilitation program supervised by a
physiotherapy .