Upper Back Pain During Pregnancy: Case Study of Penny

Assignment Task

Case Study 1: Penny  

Penny is 33 weeks pregnant and has had upper back pain for about 1 month. There was no particular reason for the pain to start and it is getting worse. She is also experiencing pins and needles and numbness in both hands and sometimes has pain in both hands during the day. She has noticed swelling in her hands also. 

Case Scenario 1: Penny Subjective information 

G2P0, 33/40 (first pregnancy-miscarriage). Gradual onset of upper back pain commencing about 5/52 ago. Has been getting worse since then. 

No previous history of back or neck pain/problems 

Also 4/52 ago woke during the night with numbness and pins and needles in both hands. Since then, she has started having pain across the hands and wrists at night and in the past 2/52 has also had daytime symptoms. Penny has noticed significant swelling of her hands and is unable to wear her rings anymore. She is R handed. 

The back pain is concerning her most today.  

Aggravating factors: Back - prolonged sitting (> 30mins) at work, driving, watching TV at night. Standing cooking dinner. 

Hands – computer use at work, driving, peeling and chopping vegetables. 

Easing factors: Back – changing position, lying down. Hands – nothing (has not tried anything). 

Night: Currently waking 2-3 times per night due to pain and numbness in hands. Returning to sleep quite quickly. 

Daily Pattern: Back pain worse at the end of the day. 

Medical history: Nil past history of similar symptoms. No relevant medical history. Good general health and pregnancy progressing well. Has had a previous early miscarriage (before 12/40). 

Medications: Pregnancy multivitamins. 

Social history: Lives with partner Chris. Work - full time as a medical receptionist (3 weeks to go until maternity leave). Current exercise – Nil 

Case Scenario 1: Penny Objective assessment 

Observations

• Minimal chest support from ill-fitting bra. Carrying baby high under ribs (as in pic below).

Other observations

• Swelling at the wrist joints bilaterally.

Posture

• Sitting - increased thoracic kyphosis, cervical & scapular protraction. Thoracic pain 4/10, decreased to 2/10 with postural correction. 
• Standing - increased lumbar lordosis, anterior pelvic tilt and thoracic kyphosis.

Cervical AROM

• Decreased cervical movements towards end of range.

Thoracic AROM

• All thoracic movements restricted due to the size of the pregnant belly.  
• Decreased thoracic rotation to the right compared to the left.
• 4/10 pain produced at EOR extension. Tight, pulling sensation with lateral flexion bilaterally. 

Thoracic palpation

• Tight thoracic erector spinae & rhomboids bilaterally.
• The key finding was at T7 with central PA pressure. First resistance at T7 with PA Gd II, followed by pain and resistance at T7 with PA Gd III and pain.
• The joints directly above and below were also slightly stiff and tender but to a lesser extent.
• Difficulty isolating lower trapezius in sitting bilaterally.

Elbow AROM

• No restrictions

Wrist AROM

• Wrist flexion= 55°
• Wrist extension= 55°

Special Tests

• +Ve Phalen’s Test, onset of pain and tingling after 20 seconds
• +Ve Reverse Phalen’s Test, onset of pain and tingling after 10 seconds
• Grip strength (Dynamometer)= 32lbs

Instructions

In words and using the Intervention Process Model as your guide:

1. Identify contextual and/or environmental factors which will impact the patient’s intervention and management.

2. Identify the main goals of treatment (2-3 goals are plenty) and provide a detailed evidence based, treatment plan that is tailored to the individual needs of the patient and their goals (steps 6 & 7 of the Intervention Process Model can be combined).

3. Include appropriate equipment/positioning/exercise recommendations etc.

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