Koronare Herzkrankheit als Ursache für Beschwerden im Bereich von BWS und Sternum

Zusammenfassung

Eine 80-jährige Patientin mit chronischen Schmerzen in der LWS, zusätzlichem Druck-/Engegefühl im Brustkorb bzw. hinter dem Brustbein sowie Atemlosigkeit vor allem bei physischer Anstrengung mit gleichzeitig auftretenden Schmerzen in der BWS zwischen den Schulterblättern wurde zur Physiotherapie überwiesen. Die Symptome im Bereich Brustkorb/Sternum und der BWS ließen sich weder durch eine Haltungsänderung noch durch Aktivität/Bewegung der oberen Extremitäten oder der Wirbelsäule auslösen bzw. reproduzieren.

Aufgrund des für koronare Herzkrankheiten typischen Beschwerdebildes wurde die Patientin zur weiteren fachärztlichen Abklärung überwiesen. Kurz darauf unterzog sie sich einer 4-fachen Bypass-Operation am Herzen.

Abstract

An 80-year old female patient with chronic low back pain, additional feelings of pressure/tightness in the chest region and behind the breast bone as well as breathlessness and concomitant pain in the thoracic spine between the scapulae was referred to physiotherapy. The symptoms in the area of chest/sternum and the thoracic spine could not be provoked by postural change or by upper limb and spinal column activity/movement.

Due to the typical clinical presentation of coronary myocardial disease, the patient was sent for further specialist assessment. A few days later she underwent a quadruple bypass heart surgery.

Schlüsselwörter

Differenzialdiagnose - Red Flags - Physiotherapie - koronare Herzkrankheit - klinischer Entscheidungsprozess

Key words

differential diagnosis - red flags - physiotherapy - coronary myocardial disease - clinical decision-making process

• Literatur

• 1 Wilkins E, Wilson L, Wickramasinghe K. et al. European Cardiovascular Disease Statistics. 2017 www.ehnheart.org/cvd-statistics/cvd-statistics-2017 (22.07.2019)
• 2 American Heart Association (AHA). Coronary Artery Disease – Coronary Heart Disease. 2015 www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Coronary-Artery-Disease---Coronary-Heart-Disease_UCM_436416_Article.jsp (22.07.2019)
• 3 Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. St. Louis: Saunders Elsevier; 2009
• 4 Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis: Saunders Elsevier; 2013
• 5 Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis: Saunders Elsevier; 2007
• 6 Boissonnault WG. Primary Care for the Physical Therapist: Examination and Triage. St. Louis: Saunders Elsevier; 2011
• 7 Gagnier JJ, Riley D, Altman DG. et al. The CARE guidelines: Consensus-based clinical case reporting guideline development. Arztebl Int 2013; 110: 603-608 doi: 10.3238/arztebl.2013.0603
• 8 Laslett M, Young SB, Aprill CN. et al. Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother 2003; 49: 89-972003
• 9 World Confederation for Physical Therapy (WCPT). Policy statement: Standards of physical therapy practice. 2011 www.wcpt.org/policy/ps-standards (22.07.2019)
• 10 World Confederation for Physical Therapy (WCPT). Declaration of Principle: Ethical Principles. 2007 www.wcpt.org/sites/wcpt.org/files/files/WCPT-DoP-Ethical_Principles-Aug07.pdf (22.07.2019)
• 11 World Confederation for Physical Therapy (WCPT). WCPT guideline for physical therapist professional entry level education. 2011 www.wcpt.org/guidelines/entry-level-education (22.07.2019)
• 12 Lackenbauer W. Periphere arterielle Verschlusskrankheit als Ursache für unilaterale Schmerzzustände im Gesäß- und Oberschenkelbereich: Fallbericht. manuelletherapie 2018; 22: 95-99 doi: 10.1055/a-0585–1558
• 13 Liu H, Fletcher JP. Analysis of Physicians’ Referrals: Is Further Diagnosis Needed?. N Am J Sports Phys Ther 2006; 1: 10-15
• 14 Davenport TE, Watts HG, Kulig K. et al. Current Status and Correlates of Physicians’ Referral Diagnoses for Physical Therapy. J Orthop Sports Phys Ther 2005; 35: 572-579 doi: 10.2519/jospt.2005.35.9.572
• 15 Ross MD, Boissonnault WG. Red Flags: To Screen or Not to Screen?. J Orthop Sports Phys Ther 2010; 40: 682-684 doi: 10.2519/jospt.2010.0109
• 16 Boissonnault WG, Bass C. Physical therapists referring patients to physicians: a review of case reports and series. J Orthop Sports Phys Ther 2012; 42: 446-454 doi: 10.2519/jospt.2012.3890
• 17 Boissonnault WG, Bass C. Pathological Origins of Trunk and Neck Pain: Part I: Pelvic and Abdominal Visceral Disorders. J Orthop Sports Phys Ther 1990; 12: 192-207
• 18 Lackenbauer W, Janssen J. Roddam. et al. Keep/Refer-Decision-Making Abilities and Screening for Serious Pathologies as Integral Components of Physiotherapy Education and Profession. physioscience 2019; 15: 28-36 doi: 10.1055/a-0833–1759
• 19 Combs JA, Caskey PM. Back pain in children and adolescents: a retrospective review of 648 patients. South Med J 1997; 90: 789-792 doi: 10.1097/00007611–199708000–00004
• 20 Henschke N, Maher CG, Refshauge KM. et al. Prevalance of and Screening for Serious Spinal Pathology in Patients Presenting to Primary Spine Settings with Acute Low Back Pain. Arthritis Rheum 2009; 60: 3072-3080 doi: 10.1002/art.24853
• 21 Hiett J, Chan D, Hourigan P. Back pain in the under 20 s would appear to be a ‘red flag‘ of dubious significance: Results of a retrospective case note analysis. Int Musculoskel Med 2014; 36: 19-22 doi: 10.1179/1753615414Y.0000000026
• 22 DeSchepper EIT, Koes BW, Veldhuizen EFH. et al. Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice. Fam Pract 2016; 33: 51-56 doi: 10.1093/fampra/cmv097
• 23 Enthoven WTM, Geuze J, Scheele J. et al. Prevalence and “Red Flags“ Regarding Specific Causes of Back Pain in Older Adults Presenting in General Practice. Phys Ther 2016; 96: 305-312 doi: 10.1093/fampra/cmv097
• 24 Reito A, Kyrölä K, Pekkanen L. et al. Specific spinal pathologies in adult patients with acute or subacute atraumatic low back pain in the emergency department. Int Orthop 2018; 42: 2843-2849 doi: 10.1007/s00264–018–3983-y
• 25 Premkumar A, Godfrey W, Gottschalk MB. et al. Red Flags for Low Back Pain Are not always Really Red. A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain. J Bone Joint Surg 2018; 100: 368-374 doi: 10.2106/JBJS.17.00134
• 26 Deyo RA, Diehl AK. Cancer as a Cause of Back Pain: Frequency, Clinical Presentation, and Diagnostic Strategies. J Gen Inter Med 1988; 3: 230-238
• 27 Henschke N, Maher CG, Ostelo RW. et al. Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Sys Rev 2013; (02) CD008686 doi: 10.1002/14651858.CD008686.pub2
• 28 Downie A, Williams CM, Henschke N. et al. Red Flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013; 347: f7095 doi: 10.1136/bmj.f7095
• 29 Williams CM, Henschke N, Maher CG. et al. Red flags to screen for vertebral fracture in patients presenting with low back pain (Review). Cochrane Database Syst Rev 2013; (01) CD008643 doi: 10.1002/14651858.CD008643.pub2
• 30 Shroyer SR, Mehta S. A More Sensitive Risk Stratification Tool for Identifying Spine Infection Than “Red Flags” or Fever. Annals Emerg Med 2013; 62: S6-S7 doi: 10.1016/j.annemergmed.2013.07.303
• 31 Germon T, Ahuja S, Casey ATH. et al. British Association of Spine Surgeons standards of care for cauda equine syndrome. Spine J 2015; 15: S2-S4 doi: 10.1016/j.spinee.2015.01.006
• 32 Verhagen AP, Downie A, Popal N. et al. Red flags presented in current low back pain guidelines: a review. Eur Spine J 2016; 25: 2788-2802 doi: 10.1007/s00586–016–4684–0
• 33 Verhagen AP, Downie A, Maher CG. et al. Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review. Pain 2017; 158: 1860-1868 doi: 10.1097/j.pain.0000000000000998
• 34 Todd NV. Guidelines for cauda equina syndrome. Red Flags and white flags. Systematic review and implications for triage. Br J Neurosurg 2017; 31: 336-339 doi: 10.1080/02688697
• 35 Cook CE, George SZ, Reiman MP. Red flag screening for low back pain: nothing to see here, move along: a narrative review. Br J Sports Med 2018; 52: 493-496 doi: 10.1136/bjsports-2017–098352
• 36 Underwood M. Diagnosing Acute Nonspecific Low Back Pain: Time to Lower the Red Flags?. Arthritis Rheum 2009; 60: 2855-2857 doi: 10.1002/art.24858
• 37 George SZ, Beneciuk JM, Bialosky JE. et al. Development of a Review-of-Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort. J Orthop Sports Phys Ther 2015; 45: 512-526 doi: 10.2519/jospt.2015.5900
• 38 Wardle F, Maskell A, Selfe J. Granulocytic sarcoma – an unusual case of shoulder pain. J Orthop Med 2007; 29: 18-22
• 39 Coulon CL, Landin D. Lyme Disease as an Underlying Cause of Supraspinatus Tendinopathy in an Overhead Athlete. Phys Ther 2012; 92: 740-747 doi: 10.2522/ptj.20110220
• 40 Wahl CE, Smith D, Sesto M. et al. Differential Diagnosis of a patient with low back and toe pain. J Man Manip Ther 2013; 21: 81-89 doi: 10.1179/2042618612Y.0000000023
• 41 Heick JD, Boissonnault WG, King PM. Physical Therapist recognition of signs and symptoms of infection after shoulder surgery: a patient case report. Physiother Theory Pract 2013; 29: 166-173 doi: 10.3109/09593985.2012
• 42 Pottkotter K, Briggs MS, Di Stasi S. Brain meningioma in a patient with complaints of low back pain and leg weakness. Physiother Theory Pract 2013; 29: 413-418 doi: 10.3109/09593985.2012.734010
• 43 Rodeghero JR, Denninger TR, Ross MD. Abdominal Pain in Physical Therapy Practice: 3 Patient Cases. J Orthop Sports Phys Ther 2013; 43: 44-53 doi: 10.2519/jospt.2013.4408
• 44 Mabry LM, Ross MD, Tonarelli JM. Metastatic cancer mimicking mechanical low back pain: a case report. J Man Manip Ther 2014; 22: 162-169 doi: 10.1179/2042618613Y.0000000056
• 45 Smith BE, Diver CJ, Taylor AJ. Cervical Spondylotic Myelopathy presenting as mechanical neck pain: a case report. Man Ther 2014; 19: 360-364 doi: 10.1016/j.math.2014.04.008
• 46 Lackenbauer W, Janssen J. Gallensteine als Ursache für muskulären Thorax-Schmerz. manuelletherapie 2016; 20: 233-236 doi: 10.1055/s-0042–119243
• 47 Lackenbauer W, Janssen J. Lyme-Borreliose als Ursache für chronische HWS-Beschwerden mit Ausstrahlungen in die oberen Extremitäten. manuelletherapie 2017; 21: 43-46 doi: 10.1055/s-0042–123728