Imaging Helps Guide Physical Therapy Treatment in a Patient With Diffuse Systemic Sclerosis (Scleroderma)

A 50-year-old woman with an 8-year history of diffuse systemic sclerosis, a form of scleroderma, was referred by her rheumatologist to physical therapy for decreased finger range of motion (ROM) and pain that adversely affected her dexterity and ability to perform activities of daily living. To determine whether joint mobilization would be appropriate for this patient, posterior-to-anterior and modified lateral radiographs of both hands were requested by the physical therapist. Images showed significant bone loss in the distal phalanges of both thumbs and in the left third and fourth digits, and calcinosis in the tips of both thumbs. Because metacarpophalangeal and interphalangeal joint spaces appeared normal, except for a slight narrowing of the right fifth distal interphalangeal joint, joint mobilization, which would have been contraindicated by bone or joint destruction, was considered appropriate to help increase ROM. J Orthop Sports Phys Ther 2018;48(3):226. doi:10.2519/jospt.2018.7662.