Musculoskeletal disorder cases 2

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Colorado School of Mines *

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4100

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Nursing

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Nov 24, 2024

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1 Musculoskeletal Disorder Cases Student's Name University Affiliation Course Professor's Name Date

2 Case 1: i. The Differential Diagnoses and The Subjective and Objective Findings The patient illness is linked with back pain a symptom that has been rated at a serious rate with a history of lifting loads at the workplace. The primary diagnosis that is considered at this stage could be muscle or ligament stain which is commonly caused by the lifting of the loads that can strain the back muscles (Fares et al., 2020). The primary diagnosis is muscle strain with the ICD 10 code of M62. 6. The subjective information given by the patient includes the chief complaint of one-day complaint of low back pain to the right. The illness can also be linked with the objective finding of radiation of the pain to the pain down to the right ankle as an illness of the back pain injury. The illness could also be sciatica pain with the ICD 10 code of M54.3 which will be treated as a differential diagnosis. Sciatica pain is linked to the serious indication of back pain with inflammation, irritation, or pinching of the lower back nerves as a chronic back pain illness (Chu, & Wong, 2021). The illness can be linked with the back pain described by the patient as subjective information and the rating of the pain as 8 out of 10 to show the intensity and the seriousness of the pain. ii. The Considered Imaging The imaging technique is used for the development of the possible illness that will be suspected by the healthcare professional. The patient indication includes back pain that radiates to the right ankle with the needed analysis of the case. In the case of the use of (Magnetic Resonance Imaging) MRI or CT scans will be applicable as they can be used to define the problems with the images of blood vessels, bones, muscles, tissue, tendons, ligaments, and nerves within the back (Pan et al., 2022). The imaging of the MRI or CT is more detailed and

3 will be applicable in determining the various possibilities as compared to the x-ray which will only give images of the ligament's alignment not showing the problems that might be recognized in the muscles, spinal cords, nerves, or disks. iii. The red flags of low back pain The red flags of low back pain are indications that can be used to determine the specialists' needs and the factors that will be used by the healthcare professional to call for thorough treatment. The patient has a history of long-term steroid use, history of cancer including the extension of cancer history within the family links, parenteral drug abuse, trauma history, and unexplained weight loss are some of the worrying parts of the patient history that can be used to determine the patient risks of developing low back pain and getting the illness to chronic level. The patient has a history of using cigarettes for the last 15 years which is a red flag in managing and treatment of his low back pain. iv. The treatment strategies The information that has been given by the patient includes the use of ice and pain relievers such as ibuprofen that did not offer a pain solution. The pain is providing to be serious radiating down the right with the need for adverse clinical solutions to help the patient in getting better. The treatment measures will need the use of other medications that can work better than over-the-counter pain relievers such as ibuprofen. The use of skeletal muscle relaxants is used when the pain relievers are not sufficient to deal with back pain with an advanced mechanism of tension reduction and relaxation of the muscles (Urits et al., 2019). skeletal muscle relaxants such as cyclobenzaprine will be prescribed for back pain problems for a short time relief of pain before other measures are considered. the patient will also need rest and massage of the muscles.

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4 v. The Need to Refer the Patient to A Specialist It is important to help the patient get well through all available healthcare measures that can be used as therapy means. The patient is already complaining of serious pain that has been rated at 8 out of 10 with a visit to the family care provider to help in dealing with the back pain. The back pain however has a history of one day only with the expectation of getting proper treatment measures at the family healthcare professional. The need of referring the patient to a specialist will not be immediate with the patient given further medication to help in managing the pain. The treatment measures should be monitored for around two weeks before the patient is referred to a specialist unless there is pain escalation that needs to be responded to by a specialist. Case 2: i. The Most Likely Diagnosis Musculoskeletal system injuries are common among athletes with the indication of fractures to the muscles and bones, sprains, strains, tendinitis, and dislocations. The patient's most possible diagnosis will be tibial apophysitis with the ICD 10 code of M92. 52 as a common illness among active children and adolescents. The pain of tibial apophysitis is linked with the childhood repetitive-use injury that develops a lump within the kneecap common among children playing sports where running is involved (Mostoufi et al., 2022). The patient illness is supported by the patient's history given with the inclusion of the patient being active in the Scholl sports team exposing him to various types of injuries with the childhood repetitive-use injuries from running around as the risk. The illness is from bone growth made worse by the patient being part of an athletic team at school.

5 ii. The pathogenesis The pathogenesis of the illness will be through descriptive of the possible causes of the tibial apophysitis as an illness linked to the growing bones and muscles and injuries to the bones, ligaments, and muscles. The tibial apophysitis has a pathogenic link of distal patella tendon ossicles that forms between the tibial tuberosity and patella tendon ossicle that can extend to the pseudo-intra-articular loose bodies caused by the bone growth plate irritation. The pain is made worse and the inflammation rate is increased by the growing bones and muscles being exposed to sports that requires running and making stops (Mostoufi et al., 2022). The history of the patient as part of the school team supports the risk of developing knee pain from tibial apophysitis. iii. The Additional Information for Diagnosis Development The patient with the exhibition of knee pain will need thorough interrogation with the healthcare professional for the establishment of the possible cause of his illness and the measures to be taken. The major causes of tibial apophysitis include enlarged tibial tuberosity, with repetitive jumping and printing (Ladenhauf et al., 2020). It would be necessary to ask about the patient involvement in sports that he has mentioned with the inquiry about previous instances of injury and the treatment therapy that was offered. I would ask the patient to give information about the warm-up they take during sports activities and the patient history of trauma and musculoskeletal injuries within the family. iv. The treatment strategies Treatment therapy is an important part of the care that needs to be observed with conclusive care taking care of the pain. The main illness that has been presented by the patient is pain in the knee without swelling and fever for the last three months. The illness that is attributed to the patient's damage to the muscles from being part of the soccer team will need the use of

6 corticosteroids which are used to treat inflammation of the muscles. The best corticosteroids used for knee pain is methylprednisolone acetate (Depo-Medrol) by athletes (McIlwraith, & Lattermann, 2019). The medication will be used alongside other therapy measures as advised by the healthcare professional such as physiotherapy needs for the patient. v. The Patient and Mother Education The management of knee pain and other musculoskeletal conditions needs the use of medication to control pain with the supplements of patient education to make therapy successful. The patient education that will be given to the duo will include supporting a diet made up of calcium to strengthen the bones and considering the other therapy means. The patient will need to stop the activities of the school soccer for some time until full recovery is attained and massaging of the knee. The patient education will also be inclusive of future problems prevention such as the need for warm up and warm down before and after engaging in vigorous exercise as part of the soccer team and monitoring small injuries that will need the care to avoid escalation of chronic musculoskeletal conditions.

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7 References Chu, E. C. P., & Wong, A. Y. L. (2021). Chronic orchialgia stemming from lumbar disc herniation: a case report and brief review. American Journal of Men's Health, 15(3), 15579883211018431. https://doi.org/10.1177/15579883211018431 Fares, M. Y., Fares, J., Salhab, H. A., Khachfe, H. H., Bdeir, A., & Fares, Y. (2020). Low back pain among weightlifting adolescents and young adults. Cureus, 12(7). doi:10.7759/cureus.9127 Ladenhauf, H. N., Seitlinger, G., & Green, D. W. (2020). Osgood–Schlatter disease: a 2020 update of a common knee condition in children. Current Opinion in Pediatrics, 32(1), 107-112. doi: 10.1097/MOP.0000000000000842 McIlwraith, C. W., & Lattermann, C. (2019). Intra-Articular Corticosteroids for Knee Pain— What Have We Learned from the Equine Athlete and Current Best Practice. The journal of knee surgery, 32(01), 009-025. DOI: 10.1055/s-0038-1676449 Mostoufi, S. A., Saulle, M. F., George, T. K., Scott, C., Chin, J., & Mostoufi, Y. (2022). Knee Disorders: Extra-Articular. In Clinical Guide to Musculoskeletal Medicine (pp. 419-450). Springer, Cham. DOI: 10.1007/978-3-030-92042-5_44 Pan, S., Zhao, Y., & Wu, S. (2022). Imaging Examination Techniques. In Radiology of Infectious and Inflammatory Diseases-Volume 5 (pp. 3-22). Springer, Singapore. DOI: 10.1007/978- 981-16-5003-1_1 Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., ... & Kaye, A. D. (2019). Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Current pain and headache reports, 23(3), 1-10. https://doi.org/10.1007/s11916-019-0757- 1

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