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.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

To prepare:

By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
Review the following case studies:

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Case 2: Ankle Pain (THIS ONE)

Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Case 3: Knee Pain

Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

With regard to the case study you were assigned:

Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3 of Week 8

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

Solution:

Review of Case Study 2: Ankle Pain

SUBJECTIVE DATA:

Chief Complaint (CC): Patient present with Ankle pain

History of Present Illness (HPI): The patient complains of bilateral ankle pain. It got worse when she heard a “pop” sound while playing soccer. The patient has a hard time bearing weight.

Medications: No past medications reported

Allergies: No evidence for allergies

Past Medical History (PSH): Not reported

Past Surgical History (PSH): Not reported

Reproductive History: Not mentioned

Immunization History: Not identified

Significant Family History: Not provided

Lifestyle: Physically fit

Possible Additional questions: Where exactly do you feel the pain? On a scale of 0-10, what is the worst pain you have experienced? Is there any reliever for your pain? When did the pain start first? Have you ever had an injury in either ankle previously? Is this the first time to feel pain in the ankle?

OBJECTIVE DATA:

Review of the Systems (ROS)

Vital Signs: Not provided

General: The patient denies fatigue, fever, or headache. Being uncomfortable while bearing weight

HEENT: Not provided

NECK: No details

Breasts: No Evidence

Respiratory: Not Provided

Cardiovascular/Peripheral Vascular: Not available

Gastrointestinal: Not available

Genitourinary: Not possible

Musculoskeletal: Ankle pain with right ankle discomfort on ambulation

Psychiatric: No information

Neurological: Patient is attentive and positioned to time and event

Skin: Not provided

Hematologic: No data provided

Endocrine: No information provided

Allergic/ Immunologic: No information regarding allergies available

ASSESMENT:

Differential Diagnosis:

Ankle Sprain: This condition is very common among sportsmen and women. Ankle sprains manifest through pain shortly after the injury, with discomforts while bearing weight (Chen, McInnis, & Borg-Stein, 2019).
Ankle fracture: Patients present with the inability to bear weight on the injured foot. A throbbing pain is a chief complaint (Kitamura, Chung, & Moore, 2019)…..Please click the icon below to purchase full answer at only $10