Physical Therapist Fails To Address Potential Femur Fracture

Case Overview

This case involves an elderly male patient with paralysis on one side of his body who fell in his home. Initial imaging was unremarkable and negative for fractures and the patient was discharged home. 3 weeks later, the patient returned to the emergency room complaining of thigh and knee pain. Orthopedics was consulted and evaluated the patient for left knee contracture. He was discharged to a physical therapy facility to improve his contractures and muscle spasms. At the facility, the patient was still unable to extend his leg and continued to experience significant pain. He was placed on increasing doses of opioids to tolerate the physical therapy. The patient was discharged home after several months and followed up with a different physical therapist. The new physical therapist ordered plain film imaging of the hip and knee which revealed a left femoral neck fracture.

Questions to the Physical Therapy expert and their responses

How frequently do you work with patients who have developed contractures and muscle spasms?

I am very familiar with lower limb contractures for various populations. I have published research regarding stroke survivors and gait with robotic knee orthoses, some who had contractures.

Given the patient's inability to tolerate the PT regimen, under what circumstances is it acceptable to continue with therapy?

Therapy could continue for pain relief and strengthening while walking cannot be tolerated. Some attempt to increase function in the presence of pain is common, though when the pattern of pain suggests bony or severe soft tissue injury, MD referral is standard.

About the expert

This expert has over 30 years of experience in the field of physical therapy. He earned his BA from the University of California, Berkeley, his MS in physical therapy from Columbia, and his PhD in health science research and education from Touro University. Today, he is a board-certified orthopedic specialist and is a member of several professional associations, including the American Physical Therapy Association. He is active in his field with more than 40 publications focused on physical therapy research. He has held a number of previous roles including as a senior physical therapist and amputee specialist at New York Presbyterian Medical Center, and as a physical therapist at Community Hospital at Dobbs Ferry. He was also the director of the physical therapy program at Touro College and then an assistant professor of physical therapy at Columbia University. Currently, he is a physical therapist at a rehabilitation center and an associate professor of clinical rehabilitation and regenerative medicine at an Ivy League medical center. Additionally, he is the associate director of faculty development and the curriculum director of the orthopedic physical therapy program at an Ivy League university in New York.

E-044407

Specialties:

Physical Therapy