Assessing Musculoskeletal Pain Essay Discussion

Response Post

The Information provided in the Focused SOAP note is very informative and was illuminating. Occurrence of a sharp, dull pain during a comprehensive physical assessment of a patient is usually a sign of an underlying musculoskeletal disorder that might need an urgent intervention. Other than dull, sharp pain, musculoskeletal conditions typically present with the following signs and symptoms, sleep disturbances, muscle twitching, and also burning sensations in the muscles that might vary with intensity and duration. Research by Korhan (2019) states that musculoskeletal disorders are usually caused by prolonged poor posture, direct blows to the muscles, bone fractures, and joint dislocation. The intensity of the pain threshold usually guides the physician on the respective medications that should be administered to the patient; most of the drugs that typically aid in relieving pain include NSAIDs, analgesics, and opiates. Conducting a comprehensive patient history will help determine any underlying risk factors of the illness, be it family or genetic history. Assessing Musculoskeletal Pain Essay Discussion

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Some of the most typical diagnostic tests that are carried out for musculoskeletal disorders include Computed topographies and also ultrasounds of the bones. A CT scan is usually conducted to determine the extent of damage to the joints and soft tissues of the bones. In contrast, the bone ultrasound will provide images of the affected structures’ muscles, tendons, and ligaments. From the differential diagnoses offered by the client, the possible condition for the client in this scenario is Patellar tendonitis. This condition is more common among athletes whose sports involve frequent jumping. The client provided in this case is a fifteen-year-old Caucasian child who plays soccer on the Junior Varsity school team. Symptoms of patellar tendonitis usually include knee pain that usually worsens when one continuously engages in sport (Hinkle& Cheever,2018). The reason as to why I have selected this condition is because it is more prevalent among students and also athletes who take part in various types of soccer.

I would first reject torn meniscus from the differentials provided in the case. It is a musculoskeletal disorder that results from a strenuous activity that forces an individual to twist or rotate the knee for instance aggressive pivoting forcefully. Despite the patient presenting with a dull, sharp paining during the examination, this was not sufficient to conclude that he actually had that disorder. The lack of stiffness and a popping sensation made me rule it out as not a differential. Second differential that I can’t entirely agree with is Bursitis; it is a painful condition that usually affects the fluid-filled sacs called the bursae that act as a cushion for both the tendons and muscles. It usually occurs when the bursae get inflamed and not during an injury. Examples of body parts that are typically affected include the hips, shoulder, and the elbow. The lack of swelling, shooting pain, and fever makes me rule it out as a differential diagnosis.

The final diagnosis that I would rule out is the Acute Knee Injury. This is simply because the client presented with a dull pain in bilateral knees, not the inability to strengthen the knee, instability, and warmth on touch. Acute Knee injury usually occurs as result of direct blow to the knee or from an abnormal twisting and bending of the knee. The diagnosis could be most likely if the patient had come with a radiograph indicating the extent of the damage that had occurred to him. The temperature on assessment was found to be 37.0 degrees Celsius, which was considered a normal finding. Assessing Musculoskeletal Pain Essay Discussion

References

Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd.

Korhan, O. (Ed.). (2019). Work-Related Musculoskeletal Disorders. BoD–Books on Demand.

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. 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.

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 Assessing Musculoskeletal Pain Essay Discussion

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:

Bilateral Knee Xray

Bilateral Knee MRI Assessing Musculoskeletal Pain Essay Discussion

A.

Differential Diagnoses

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

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).” Assessing Musculoskeletal Pain Essay Discussion

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).

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Patellar Tendonitis: This was considered as a differential diagnosis due to the patient’s 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’s likelihood of developing patellar tendonitis.

Arthritis: This was considered due to the patient’s 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 Discussion