Hi Carol,
Thanks for your email. Please see comments below.
>Hi Tobias - from the info you've given I'm not sure it's definitely
>costochondritis - you may have checked the following but hope it's
>helpful -
>If pain is worst after inactivity and in the morning - could it be a
>seronegative arthritis - eg. has ankylosing spondylitis been ruled out?
>You won't get rheumatoid factor in these forms of arthritis.
>It may be worth checking:
--> Yes, I too reflected on seronegative arthritis, but currently NO status on this. MD will order further laboratory tests if initial drugtherapy and PT has no or little respons.
>- other tender points - may be enthesitis: trochanteric bursae, ischial
>tuberosities, iliac crest, insertion of tendo achilles, insertion of
>plantar fascia. Tenderness in anterior chest and spinous processes could
>also be enthesitis rather than joints.
--> No other than T-spine and anterior rib articulations. BUT, past medical history 5 yrs ago suspected lumbar disc herniation L4-5; conservative treatment, physical training and better...
>- what are SI joints like
--> Not possible to provoke pat's pain/symtoms from SIs
>- ask about eye problems (blurring/redness could be iritis)
--> Yes, pat admits having iritis 9 yrs ago (bilateral for 2 wks) during military training. Not sure though if/or this could be correlated with current symtoms with this long time span?
>- ask about bowel problems either present or recent past (secondary to
>infective enteropathy or inflammatory bowel disease)
--> NO such symtoms
>- any psoriasis? (may be hard to find)
--> NO such symtoms
>Blood results - what is his erythrocyte sedimentation rate (or
>equivalent), has HLA B27 been checked?
--> MD will confirm lab results next week... and I will see pat twice next week...
Thanks for your input Carol,
Tobias
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Tobias Sundberg, PT
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