Discussion: Assessing Musculoskeletal Pain

I must admit that the presentation of your episodic SOAP is impressive and comprehensive. Besides, you adhered to all the required components of an episodic SOAP. Based on the presenting complaint of your assigned case scenario, it is straightforward that the patient needed a comprehensive assessment of her injured ankle.  Most patients with injuries of the ankle joint sustained either as a simple fall or recreationally visit emergency departments in hundreds and thousands annually across the globe (American Orthopaedic Foot & Ankle Society, 2015). Most of them tend to either have sustained a simple soft tissue ligament injury or a small avulsion fracture that may have no clinical significance. Only a minority tends to sustain serious fractures that might require internal fixation or immobilization.Discussion: Assessing Musculoskeletal Pain

Distinguishing between these patient groups is not always easy for some clinicians especially in cases of inconsistencies in assessments and radiology use.  Ball et al (2019) also recommend that this is where APRNs can apply instruments such as the Ottawa Ankle Rules which you comprehensively did. I also agree that this is a good instrument that guides clinical decision making with regards to determining the most appropriate indications for radiography and in guiding the assessment of ankle injuries (American College of Foot and Ankle Surgeons, 2018). Based on the subjective data, a history of playing soccer, and a ‘pop’ sound also increase the likelihood of a grade 2 Lateral Ankle Sprain diagnosis since most sports injuries happen during a sports-related activity that results in an audible pop or tear.

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References

American College of Foot and Ankle Surgeons. (2018). Ankle Sprain. Retrieved from https://www.foothealthfacts.org/conditions/ankle-sprain

American Orthopaedic Foot & Ankle Society. (2015, June). Ankle Sprain. Retrieved from http://www.aofas.org/PRC/conditions/Pages/Conditions/Ankle-Sprain.aspx

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby

Discussion: Assessing Musculoskeletal Pain

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:Discussion: Assessing Musculoskeletal Pain

Case 1: Back Pain

Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.

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

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.Discussion: Assessing Musculoskeletal Pain

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 (Case 1: Back Pain). 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.

By Day 6 of Week 8

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.

Discussion: Assessing Musculoskeletal Pain