On physical examination RP clothed in a bathrobe and pajamas, is stooped, ill-nourished, and ambulates with a walker. He is alert, afebrile and in apparent respiratory distress with any simple movement or exertion. He's in obvious pain. No airway stridor, drooling or cough is observed. Skin vitals are warm, dry and pink.
Chiropractic assessment yields joint fixation of the lower lumbar vertebrae.
Asymmetry in the position of the lumbosacral muscles with slight soft tissue swelling is noted. Palpable pain is elicited at the right sacroiliac joint. Neurological and orthopedic examination is essentially negative with the exception of slight rubor quality to the lower extremities at the ankles, nonpitting edema, and reduced sensation of the bilateral L3-L5 dermatomes that are attributed to analgesic medication and geriatric pain perceptions. Radiographic imaging studies are not performed to evaluate his spine. The consequences of chronic pain among older people are numerous.