Treatment Recommendations

1. Radiographs of the lumbar spine and sacroiliac joint are not necessary at this time. If conservative care increases pain, or the clinicians short term goals (measured through the Modified Oswestry Scale) are not met, then digital radiographs should be considered. There is some limited literature that suggests adjusting the SI joint with a sprain is beneficial. Thomas Souza, D.C., makes the recommendation that in the acute and sub-acute phase of SI sprains chiropractic adjustments should not be rendered, instead provide the patient with a SI belt for stabilization. The patient is in the sub-acute phase of her injury and her pain is at a moderate intensity. It would be up to the doctor to decide what is best. If a side posture position increases pain then a prone “drop” approach can be helpful to stimulate mechanorecptors and proprioceptors. Icing after activities (until the area is numb) that increase the pain can be helpful. Avoiding hills and uneven ground for the next 4 weeks would be ideal. No fast paced walking, and avoid increasing stride length for 4 weeks as well. Squats, and lower extremity rehab may not be ideal during this sub-acute stage especially for this patient with other complaints.

Treatment Frequency: Up to 3 times per week for the first 4 weeks as indicated by the severity of involvement and the desired effect, then up to 2 treatments per week for the next 4 weeks with re-evaluation for evidence of functional improvement or need for further workup. Continuance of her treatment will depend upon functional improvement.

To address the co-morbidities:

Patients with jaundice due to intrahepatic problems may have had symptoms for less than 2 weeks (i.e., acute hepatitis of any cause) or more than 2 weeks (i.e., cirrhosis, chronic hepatitis, familial liver conditions). Abdominal pain often plays a minor role in the patient's history, while the major complaints are usually malaise, fatigue, and other constitutional symptoms like this patient had. From a diagnostic standpoint, sonography of the liver, biliary tree, and pancreas should be the first specific imaging screening test. If biliary dilation is present, the patient should have either PTC or ERCP. If sonography is equivocal or if the sonogram is interpreted as normal but there is a strong clinical suspicion of biliary obstruction, CT or HBS should be performed. If there is no imaging evidence of obstruction and hepatocellular disease is suspected, a needle liver biopsy is indicated.

Her history states that she is a non-drinker, however no information was gathered about her sexual history. This would be important to gather to see if there is a connected with her autoimmune disease or a viral hepatitis infection.