Assessing Musculoskeletal Pain Essay Example

Assessing Musculoskeletal Pain Essay Example

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Musculoskeletal Pain Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

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Below is the case study to use for the reply:
Review of Case Study 3
COLLAPSE
Episodic/Focused SOAP Note Template

 

Patient Information:

J.K., 15, Male, Caucasian

S.

CC: I have a dull pain in both knees.

HPI:

Location: bilateral knees

Onset: 4 days ago

Character: dull

Associated signs and symptoms: sometimes one or both knee clicks, catching sensation under the patella

Timing: after physical activity

Exacerbating/ relieving factors: physical activity increases dull pain; ice and ibuprofen help relieve pain to 3/10 pain scale

Severity: 6/10 pain scale

Current Medications: Ibuprofen 200mg, takes 4 tabs PO BID; taking since yesterday, last dose taken this morning

Allergies: No known medication allergies, denies any environmental, food, or latex allergies

PMHx: Denies any medical history, no hospitalizations or surgeries; states up to date with immunizations according to CDC guidelines

Soc Hx: High school student grade 10, plays soccer on Junior varsity school team; denies alcohol or tobacco use; states never sexually active; endorses seat belt use each time in vehicles; states working smoke detectors in home; endorses safe living environment; states positive support system at home

Fam Hx: Denies family history of contagious illnesses; states father with history of arthritis bilateral knees, age 44; mother healthy age 41; sister age 17 asthma; brother healthy age 10; maternal grandmother died age 46 MVA; maternal grandfather died age 60 stroke; paternal grandmother living age 76 diabetes and HTN; paternal grandfather living age 77 HTN, osteoarthritis

ROS:

GENERAL: Denies weight loss, fever, chills, weakness, or fatigue

CARDIOVASCULAR: Denies chest pain or pressure. Denies peripheral edema

RESPIRATORY: Denies shortness of breath, denies breathing difficulties

MUSCULOSKELETAL: Endorses dull pain bilateral knees, 6/10 pain scale; denies back pain or stiffness

PSYCHIATRIC: States no feelings of depression or anxiety

ALLERGIES: no known medication allergies; denies any environmental, food, or latex allergies

O.

Physical exam:

GENERAL: Well-appearing 15-year-old Caucasian male with dull pain in bilateral knees

Vital signs: BP: 114/76; SpO2: 99%; HR: 38; RR: 20; Temp: 37C; Weight: 120 lbs, Height: 5’7”; BMI: 18.8%
CARDIOVASCULAR: No JVD; Carotid upstrokes brisk, without bruits. Auscultated crisp S1 and S2. No murmurs or extra sounds

RESPIRATORY: thorax is symmetric with good expansion. Lungs resonant, breath sounds vesicular; no rales, wheezes, or rhonchi. Diaphragms descend 3 cm bilaterally
MUSCULOSKELETAL: symmetrical abdomen, no abnormalities noted; no edema noted in bilateral lower legs; no edema on bilateral arms; mild edema noted to bilateral knees at level of patella, not hot to the touch, sensitive to light and deep touch; negative McMurray test on Left knee, positive McMurray test on Right knee; negative ballottement test; flexibility of Left knee to 90 degrees, Right knee to 70 degrees

PSYCHIATRIC: Responds to questions with appropriate affect and manner

Diagnostic results: Assessing Musculoskeletal Pain

Bilateral Knee Xray

Bilateral Knee MRI

A.

Differential Diagnoses

Torn Meniscus
Acute Knee Injury
Bursitis
Patellar Tendonitis
Arthritis
Reasons for Choosing Differential Diagnoses

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Torn Meniscus: Supporting evidence for diagnosis includes positive McMurray test for Right knee. This patient would benefit from meniscus repair to the Right knee, as an article showed that Meniscus repair has a healing rate ranging from 33 to 100% with less than 40% reoperation rate (Yang et al., 2019).”
Acute Knee Injury: Chosen for generalized diagnosis of acute pain as evidenced by onset of 4 days as well as inability to flex the right knee to 90 degrees. According to the textbook, In cases of acute knee injury, the Ottawa Knee Rules identify the characteristics of patients who should have a radiograph of the knee. The rules include any of the following findings: Isolated tenderness of the patella (Ball et al., 2019).

Bursitis: Prepatellar bursitis is an inflammation of the bursa in the front of the kneecap (patella) (Orthoinfo, n.d.) . This was ultimately not chosen as the primary diagnosis because the patient was not having hot to the touch symptoms or rapid swelling signs that are included in bursitis as well as negative ballottement test (Ball et al., 2019).

Patellar Tendonitis: This was considered as a differential diagnosis due to the patient social history; he is a soccer player. A study states that High mechanical strain is thought to be one of the main factors for the risk of tendon injury, as it determines the mechanical demand placed upon the tendon by the working muscle (Mersmann et al., 2019). Soccer involves high mechanical demand on the knees and increases the patient likelihood of developing patellar tendonitis.

Arthritis: This was considered due to the patient familial history of osteoarthritis with his paternal grandfather. An article showed that Personal history of knee injury or surgery and family history of knee osteoarthritis or joint replacement are established risk factors for knee osteoarthritis. Additional risk factors for knee osteoarthritis include age older than 50 years, female gender, and being overweight (Bunt et al., 2018).This was ultimately not chosen as the primary diagnosis due to the patient not having any direct parent history of osteoarthritis and not having any of the additional risk factors such as age over 50 years, female gender, and being overweight; as the patient is 15, a male, and has a normal, healthy BMI.

Assessing Musculoskeletal Pain Essay Example

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