No more sex? Interesting patient case

Red flags are well known in physiotherapy world. As a profession, we are getting more and more independent. Is it enough to be safe? Are we sure we don’t not miss important symptoms?

My friend had interesting patient in his office. Mr. T., male, 28, computer job, came with pain on the right side of the neck. Pain was in the line of trapezius muscle from occiput to acromion (like a band). Patient goal was to get rid of the pain. No other symptoms or pain.

Symptoms started couple weeks before, while exercising in the gym. Pain was sudden, sharp and strong. Pain was increasing during exercises, especially when intensity increased. It was not that important what kind of exercise he was doing. Later Mr. T noticed his pain during sexual activities. Symptoms especially increased at the moment of ejaculation. Mr T. had couple manual treatments with no success. He also visited a doctor and got pain killers but it didn’t work. His health was good, heart OK, no head injuries in history, no other treatment, no medicines, never problems like this before, no medical imaging.

During physical examination nothing special was found. Posture could be better, muscles on the right side of the neck were slightly more tens, but there was no present pain. There was no pain in active movement and ROM was full. No pain in passive movement, also with overpressure. Neurological examination was OK. What to do now?

It is well known that during exercises, also sexual activities, heart rate and blood pressure increase. After the visit my friend sent patient to a doctor with suggestion additional head imaging. His colleague doctor, neurologist ordered computed tomography angiography. It appeared patient had cerebral aneurysm, the reason for his pain.

After C/O and P/E it was clear that this patient is not for physiotherapy. But is it enough to “just” send patient to the doctor? Should we or shouldn’t suggest certain procedures to other health professionals? I really believe we should, how we do it is usually the key to success. Since May 2016 Polish physiotherapists have official direct access. The more often we will have patient as a first contact medical specialists, the more often we will have patient which should be send to the doctor for additional examination and treatment. The more we know about medical screening procedure the faster patient will get to right specialist.

I am curious how it is in Your countries? Do you have direct access? Legal or just unofficial?

Regards,

Zbyszek Wronski

Ps. If we think about our patient what can he do? Is “no more sex” the only option?

1. Differential Diagnosis in Physical Therapy, Catherine C. Goodman and Teresa Snyder, Saunders; 5 edition (2012)

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