Musculoskeletal Diseases Essay Assignment

INSTRUCTIONS

Respond to a colleague by Analyzing 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. APA FORMAT WITH at least 3 scholarly resources

COLLEAGUES SOAP NOTE:

Episodic/Focused SOAP Note Template Musculoskeletal Diseases Essay Assignment

Patient Information:

CS, 42-year-old, Male, Caucasian

S.

CC : Low Back Pain

HPI: The patient is a 42-year-old, Caucasian male who reports low back pain that radiates down left leg for the past month.

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Location: Lower Back

Onset: 1 month

Character: Sharp and radiating to left leg

Associated signs and symptoms: None

Timing: Pain is worse when sitting or standing for long periods of time.

Exacerbating/ relieving factors: Sitting or Standing for long periods of time. Pain is relieved with ibuprofen.

Severity: 8/10 pain scale

Current Medications:

Lisinopril 10mg daily

Ibuprofen 600mg every 6 hours as needed for pain.

Allergies:

No known drug allergies, no food, or seasonal allergies.

PMHx:

Hypertension was diagnosed at age 30.

Declines Influenza Vaccine

TDAP in 2022

Up to date on childhood vaccines

Declines COVID vaccines

No surgical history.

Soc Hx:

C.S works in the IT department for a community hospital. Lives alone and denies being married or having any children. Denies smoking, reports drinking socially on the weekends about 5 beers. Denies any illicit drug use. Reports joining a gym 2 months ago and exercised 3-4 days per week up until he started having back pain a month ago. He reports eating a healthy diet, trying to avoid sugars, sodium, and carbs as much as possible. Patient states he plays soccer and video games for fun. Reports seeing PCP every year for routine visits. Self-monitors blood pressure at home once a week.

Fam Hx: Mother is still alive at age 75 with a history of high cholesterol and arthritis. Father is living at age 75 with a history of hypertension and CHF. Musculoskeletal Diseases Essay Assignment

Brother age 40 has history of high cholesterol

Maternal grandparents both deceased at young age of 40 in car accident with no known medical history.

Paternal Grandmother deceased at age 92 from pneumonia, had history of hypertension and osteoporosis.

Paternal Grandfather deceased at age 86 from hemorrhagic stroke after a fall. Had a history of dementia, arthritis, and hypertension.

GENERAL:  Patient is awake, alert and oriented to person, time, place and situation, well nourished, no distress, mildly uncomfortable from lower back pain

HEENT:  Eyes: Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN:  Negative for skin lesions. Denies rash or itching.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Elevated respiratory rate at 30bpm, denies difficulty breathing, coughing or shortness of breath.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  No changes in bladder habits. Denies difficulty urinating or burning upon urination.

NEUROLOGICAL:  Tingling and numbness to left leg. Denies headache, dizziness, syncope, paralysis, or ataxia. No change in bowel or bladder control.

MUSCULOSKELETAL:  Low back pain that radiates to left leg.

HEMATOLOGIC:  Denies anemia, bleeding, or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety. Denies stressors at home.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Denies history of asthma, hives, eczema, or rhinitis.

O.

Physical exam:

Vitals: BP 182/94, P 102, RR 30, T 98.1, O2 99% on RA. WT 185lbs HT 70”

GENERAL: patient appears mildly uncomfortable, holding lower back, tachypnea and tachycardic. Musculoskeletal Diseases Essay Assignment

NEUROLOGIC: Awake, alert oriented x4, Speech is clear without facial drooping, no vision changes, follows movements. Positive slump test (Majlesi et al., 2008).

RESPIRATORY: Tachypnea, the chest expands symmetrically, no adventitious breath sounds.

CARDIOVASCULAR: Tachycardic at 102, S1and S2 sound heard. All peripheral pulses are strong and palpable +3, Negative edema to all extremities. Capillary refill is less than/equal to 3sec.

MUSCULOSKELETAL: Low back pain radiating to the left lower extremity. No evidence of trauma to affected area. Pain increases with flexion, extension, and twisting. Decreased mobility due to pain

Diagnostic results:

CT Lumbar spine

CT Pelvis

Lab work would not be necessary at this point. There is no indication of infection or abnormal electrolyte. A CT would reveal any herniating, or fracture present.

A.

Differential Diagnoses:

Lumbar Disc Herniation:  80% of the population sustains an episode of low back pain. Within the vast differential of low back pain, the most common source is degenerative disc disease and lumbar disc herniation. The most common symptoms of herniation are radicular pain, sensory abnormalities, and weakness in the distribution of one or more lumbosacral nerve roots. Focal paresis, restricted trunk flexion, and increased leg pain with straining, coughing, and sneezing are also sound in these patients. Patients like MR. C.S frequently report increased pain when sitting, which is due to increased disc pressure. Local corticosteroids are a common treatment option. There are surgical options but there is no guarantee of the length of relief that will be provided (Armin et al., 2017). Musculoskeletal Diseases Essay Assignment

Sciatica: This type of pain related to sciatica is often worsened with twisting, bending, or coughing. This is often a chronic condition that is managed through using pain medication and NSAIDs to help relive pain and inflammation. The pain is a result of the sciatic nerve. Patients experience pain and paresthesia in the sciatic nerve which is located near L4 through S2. The sciatic nerve provides motor function to the hamstrings, lower extremity adductors, and indirect motor function to the calf muscles, anterior lower leg muscles, and some intrinsic muscles (Davis et al., 2022). This is why numbness and tingling in the affected extremities occur. The nerve becomes inflamed, and the pain can resolve on its own eventually without medical treatment or NSAIDS can help with the inflammation.

Lumbar Strain: I suggested a lumbar strain because the patient joined a gym roughly 1 month before the pain began. It is easy to strain muscles while lifting weights especially if twisting is involved and proper body mechanics are not utilized. Most patients do not remember an incident occurring to cause the pain. Physical exam red flags to assess for include focal neurologic deficits, including weakness, ataxia, saddle anesthesia, decreased deep tendon reflexes, and diminished rectal tone (Sayed et al., 2022). Musculoskeletal Diseases Essay Assignment

Ankylosing Spondylitis: This is more of a chronic condition causing spinal stiffness and pain but primarily affects the joints. This is a chronic inflammatory disease. Lab tests will assist in this diagnosis but checking a ESR and CRP. This diagnosis is not likely but cannot be excluded (Wenker & Quint, 2023).

Lumbar Compression Fraction: This is very common in patients with osteoporosis and increasing age. It is not likely that this patient has osteoporosis especially being this is a male patient. However, he does have a family history. Bone density begins to decrease after age 40 for both men and women. Though genetic predisposition and age of puberty onset play a significant role, a multitude of lifestyle and environmental factors increase the risk of developing osteoporosis (Wong & McGirt, 2013). This diagnosis is not likely but cannot be excluded as the patient is above age 40, has a family history of osteoporosis and recently joined a gym. Musculoskeletal Diseases Essay Assignment

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

1. Majlesi, J., Togay, H., Unalan, H., & Toprak, S. (2008). The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 14(2), 87–91. https://doi.org/10.1097/RHU.0b013e31816b2f99Links to an external site.
2. Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar Disc Herniation. Current reviews in musculoskeletal medicine, 10(4), 507–516. https://doi.org/10.1007/s12178-017-9441-4Links to an external site.
3. Davis D, Maini K, Vasudevan A. Sciatica. [Updated 2022 May 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507908/Links to an external site.
4. El Sayed M, Callahan AL. Mechanical Back Strain. [Updated 2022 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542314/Links to an external site.
5. Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/Links to an external site.
6. Wong, C. C., & McGirt, M. J. (2013). Vertebral compression fractures: a review of current management and multimodal therapy. Journal of multidisciplinary healthcare, 6, 205–214. https://doi.org/10.2147/JMDH.S31659 Musculoskeletal Diseases Essay Assignment

Discussion Response post

I appreciate your careful examination of possible conditions based on the SOAP note that you provided. I value your efforts in considering multiple differential diagnoses and offering pertinent information. I however have a few observations that I would like to share.

I would reject the possibility of Ankylosing Spondylitis for a few reasons. The patient’s acute episode of low back pain with radiating symptoms down the left leg does not align well with the chronic nature of Ankylosing Spondylitis, which primarily affects the joints and causes spinal stiffness (Ebrahimiadib et al., 2021). Furthermore, the patient’s demographic (42-year-old male) and the absence of other related symptoms or a family history of ankylosing spondylitis make this diagnosis less likely. I woMusculoskeletal Diseases Essay Assignmentuld also reject the diagnosis of Lumbar Compression Fracture. The demographic and the mechanism of injury described do not typically lead to vertebral compression fractures (Hoyt et al., 2020). This condition is more common in older individuals, particularly postmenopausal women with osteoporosis.

According to the information, Lumbar Disc Herniation is the differential diagnosis with the highest likelihood (Al Qaraghli & De Jesus, 2020). This condition is consistent with the patient’s acute low back pain that radiates down the left leg (radicular pain) and worsens with extended sitting or standing. The positive slump test result during the neurologic evaluation adds credence to the idea that the lumbar disc may have ruptured. How the patient responded to the anti-inflammatory drug ibuprofen implies that disc herniation may have an inflammatory component.

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I concur with your analysis that lumbar disc herniation is the most likely diagnosis in this situation. It is imperative to validate this diagnosis. The patient’s age, symptom, physical examination results, and treatment reaction fit this diagnosis well. While awaiting the availability of imaging data and further analysis, we should keep other options on the board. Musculoskeletal Diseases Essay Assignment

References

Al Qaraghli, M. I., & De Jesus, O. (2020). Lumbar disc herniation.

Ebrahimiadib, N., Berijani, S., Ghahari, M., & Pahlaviani, F. G. (2021). Ankylosing spondylitis. Journal of Ophthalmic & Vision Research, 16(3), 462.

Hoyt, D., Urits, I., Orhurhu, V., Orhurhu, M. S., Callan, J., Powell, J., … & Viswanath, O. (2020). Current concepts in the management of vertebral compression fractures. Current Pain and Headache Reports, 24, 1-10. Musculoskeletal Diseases Essay Assignment