Cushing Syndrome

A 38-year-old female who works as a certified nurse assistant in a nursing home arrived complaining of upper and lower back pain which started 3 years ago after transferring a patient from wheelchair to bed. Patient reports that she has been suffering from back pain since then for which she has received all kinds of conservative treatment, including prior physical therapy for which she specifies hot packs and massage about 8 months ago. She reports having received multiple corticosteroids injections as well as oral corticosteroids for multiple periods of time prescribed by different physicians for pain control. The past medical history includes hypertension. Patient denies any history of osteoporosis and has never received a bone density test. In addition, patient reported that she feels very depressed because she has been unable to get pregnant. Upon observation, patient appears with central obesity and thin extremities (all four), kyphotic posture, thick neck, and round moon like face. During examination, patient presents pain upon palpation at C7-T2 and L3-S1 paraspinals with tender points, diminished ROM in the lumbar and cervical spines, and mild decreased strength in all four extremities. Patient presents with difficulty with IADLs and job related duties. Laboratory tests showed abnormally high urine cortisol levels. CT scan of the brain was normal. Bone density test showed osteopenia.

Question: What are two of the priority impairment to address with this patient, and what physical therapy interventions would be most appropriate to do so?

Potential answers:

A. Depression and pain. Physical therapist should provide prescriptions of antidepressants and narcotics to address these issues.

B. General muscle weakness and decreased ROM affecting IADLs and job related duties. Physical therapist should provide strength training, energy conservation methods, and ROM exercises to address these issues.

C. Obesity and depression. Physical therapist should provide nutrition advice and prescriptions of antidepressants to address these issues.

D. General muscle weakness and pain. Physical therapist should provide energy conservation methods and narcotics to address these issues.

Answer: B. General muscle weakness and decreased ROM affecting IADLs and job related duties. Physical therapist should provide strength training, energy conservation methods, and ROM exercises to address these issues.

For more information see Chapter 21: Cushing Syndrome in The Color Atlas of Physical Therapy.