Rehabilitation Decision-making for Lower Extremity Sarcoma with Undiagnosed Metastases: A Case Report

This case report describes the physical therapy management and clinical decision-making for a 67-year-old female patient with an initial left-hip sarcoma which subsequently metastasized. The patient had significant physical pain and emotional distress after her surgery and radiation. The patient presented to physical therapy (PT) with left hip pain and pain in the left flank and left shoulder. These issues were significantly affecting her quality of life and activities of daily living. She had undergone a previous bout of outpatient PT that did not resolve her pain. A thorough PT evaluation was completed and conservative management of the patient’s pain was initiated but she did not experience sustainable pain relief. Later it was discovered that the patient had developed spinal metastatic lesions and the pain was likely caused by a pathological fracture that was not identified upon physical examination or previous imaging. Based on this, the physical therapist chose to conduct physical therapy due to the increasing pain, and then referred her back to the physician for further evaluation of imaging results and reevaluation of the patient’s symptoms. The initial diagnosis and metastatic spread of the sarcoma had a significant negative influence on the patient’s quality of life and participation in her activities of daily living. When working with any patient with a history of cancer, metastatic disease should remain high on the differential diagnosis list and should be a focus of any new unexplained pain.