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Assignment:
Respond to at least two of your colleagues 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 using current resources. Remember to include outside resources.
Case study: Back Pain
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?
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1) Post by: Mar An Elli
Episodic/Focused S OAP Note
Patient Information:
D.J., 42, Male, Caucasian
S.
CC: Low back pain
HPI: Patient D.J. is a 42- year-old Caucasian male presenting to the clinic with low back
pain with onset beginning one month ago. Patient states the pain feels “achy and dull”
and at times radiates to his left leg stating it is worse behind his knee. Patient states the
pain is constant and is exacerbated by standing and walking and is relieved by laying
supine and sitting. Patient states some relief from PRN Ibuprofen. Pain is currently 8/10
on the pain scale.
Current Medications: Patient takes no regular prescription medications or supplements.
Patient takes Ibuprofen 600mg PO Q6 PRN for pain.
Allergies: Patient states no drug allergies. No food, environmental or latex allergies
reported.
PMHx: Patient has no Hx of major illnesses or hospitalizations- no surgeries. Patient had
influenza vaccine one month ago and covid booster in June 2023. Patient is up to date
on immunizations.
Soc Hx: Patient is currently a tow truck driver with Superior Towing for the past 18
months. Prior to this, the patient worked on a loading dock – loading trailers and lifting
50-75lbs at a time 40 hours a week for 12 years. Patient hobbies are restoring vintage
furniture for resale and attending car shows. Patient is single and heterosexual, patient
denies being currently sexually active. Denies Hx of STD’s- no children. Patient vapes
nicotine 2-3 times per week. Patient denies ever using illicit drugs or alcohol. Patient
states he uses his seat belt when driving and has 4 smoke detectors and one carbon
monoxide detector in his home. The patient lives alone in a 2-bedroom apartment and
states his mother lives next door. Patient states he is active in the community and helps
at the local boys and girls club. Patient states he has many friends he often visits.
Fam Hx:
Mother: Hx of obesity and hypertension.
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Father: deceased at 46 in an MVA- Hx of hypertension.
Maternal GM: Died at age 40 in childbirth- no medical Hx.
Maternal GF: Died of Alzheimer type dementia at 92- Hx of hyperlipidemia and
hypertension.
Maternal GM: Deceased at 88 from MI- Hx hypertension.
Maternal GF: Died of colon CA at 78. Hx of obesity and DMII
No siblings or children
ROS
GENERAL: Denies fatigue- denies weight loss. Patient A&Ox3 – states pain in lower
back currently 8/10.
HEENT: Denies change in LOC or headache. Patient wears glasses to read with his last
eye exam 6 months ago. No Hx of eye trauma or eye disease. Pt. denies ear pain or loss
of hearing- denies vertigo, denies infection. Denies epistaxis or rhinorrhea- denies Hx of
obstruction or issues sense of smell. Denies sore throat and no issue with swallowing- no
hoarseness or loss of voice. Patient has tonsils intact. No Hx strep infections, Dental
exam one month ago.
NECK: Denies pain or tenderness.
SKIN: Denies itching or rash.
CARDIOVASCULAR: Denies history of hypertension- denies CP. Denies palpitation or
Hx of edema.
RESPIRATORY: Denies cough or SOA. Denies orthopnea.
GASTROINTESTINAL: Denies nausea, vomiting or diarrhea. Denies pain.
GENITOURINARY: Denies burning with urination or incontinence.
NEUROLOGICAL: States some numbness to left great toe- denies Hx headache- Denies
change in bowel or bladder.
MUSCULOSKELETAL: States pain in lower back and radiation down back of left leg to
below the knee. Denies Hx of injury or trauma. Denies Hx of gout.
HEMATOLOGIC: Denies bruising easily or bleeding. Denies anemia.
LYMPHATICS: Denies lymph node swelling – denies Hx splenomegaly or splenectomy.
PSYCHIATRIC: Denies SI/ HI or Hx of anxiety. Denies depression.
ENDOCRINOLOGIC: Denies heat/ cold intolerance – denies polydipsia or polyuria.
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ALLERGIES: Denies seasonal allergies or asthma. Denies eczema.
O.
Physical exam:
General: Patient is an appropriately dressed Caucasian male – Patient appears
uncomfortable- shifting weight from side to side while sitting in chair. Patient grimaces
when moving.
VS: B/P: 138/78 P: 86 R: 16 O2: 99% HT: 5’10” WT:196
Cardiovascular: s1, s2 auscultated / no murmurs or rubs- no clicks or gallops- HR 86
Respiratory: clear all quadrants with no adventitious sounds present.
Musculoskeletal: Spine vertically aligned/ symmetrical scapula bilaterally. Normal Scurve noted.
No masses or abnormal hair growth noted. No tenderness noted on palpation. Lower
extremities symmetrical in length. No muscle atrophy is noted.
Abnormal gait- listing to the left. Negative FABER test. +SLR with pain present when
raised at 50% to below the knee. ROM normal bilateral hips.
Lymph: No node enlargement noted upon palpation.
Diagnostic results: SED rate and C-reactive protein to R/O chronic inflammation or
infectious cause; as these are inflammatory markers (Al Qaraghli & De Jesus, 2023). MRIdeferred – see patient again in two weeks to see if pain improves with treatmentStatistically, most lower back pain will. Improve within six weeks. MRI imaging. Is. Often
unnecessary in suspected cases of sciatica., and often areIcontraindicated due to the
high levels of radiation that the patient would possibly be exposed to unnecessarily.
(Hall, A.M. et al. 2021). If pain persists- an MRI would be performed at that time. Also, if
pain persists- a physical therapy consultation may be useful.
A.
Differential DX:
•
•
Sciatica- is a debilitating condition that causes pain and possible paresthesia
or numbness in lower extremity. The sciatic nerve is made up of L4-S1 nerve
roots. The most common cause of Sciatica is a bulging or herniated lumbar
intervertebral disk. It is common to have radiating pain to the lower
extremity usually on one side. This patient had a + SLR test which is used to
help definitively diagnose sciatica (Pesonen, J. et al. 2021).
Spondylolisthesis- Spondylolisthesis happens when one vertebra slips out of
place onto the vertebra below it. This happens to 4 to 6% of the population
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•
•
•
and can be a degenerative change. Vertebral slipping puts pressure on the
bone below it and can cause pinching of nerve roots and can cause leg pain.
Most grade I and grade II. types require no surgery. Almost all cases of
degenerative spondylolisthesis are in this category (2023).
Spinal Stenosis- stenosis is a condition where nerve roots are compressed by
a pathologic factor causing pain, numbness, and weakness. It can be acquired
or congenital. Acquired stenosis Occurs from degenerative changes or
trauma. Degenerative changes occur when there is a narrowing of the central
canal and lateral recess from post disc herniation, ligamentum, flaven
hypertrophy and spondylolisthesis (Avais et al., 2023).
Lumbar Disk Herniation- 80% of the population experience low back pain. In
their lifetime. Intervertebral degeneration is the most common reason for
lower back pain. Intervertebral degeneration disease leads to lumbar disc
herniation. This becomes more common with aging. In lumbar disc herniation,
signs and symptoms can include radicular pain, low back pain, limited trunk
flexion, exacerbation of pain with strain, pain more intense when seated (Al
Qaraghli & De Jesus, 2023).
Degenerative Disk Disease – Degenerative disc disease is characterized by
breakdown of one or more discs separating bones of the spine, causing neck
or back pain. This can happen any time after 40 years of age and can be mild
or severe. Obesity can play a part in degenerative disc disease and one of the
main ways it is treated is maintaining healthy weight and exercising (Donnally
et al., 2023).
References
Al Qaraghli, M. I., & De Jesus, O. (2023, August 14). Lumbar disc herniation – statpearls NCBI bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560878/
Avais, R., Hoang, S., Patel, P., & Mesfin, F. (2023, June 12). Spinal Stenosis – StatPearls NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK441989/
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.
Donnally, C., Hanna, A., & Varallo, M. (2023, August 4). Lumbar degenerative disk disease statpearls – NCBI bookshelf. Lumbar Degenerative Disk Disease.
https://www.ncbi.nlm.nih.gov/books/NBK448134/
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Hall AM, Aubrey- Bassler K, Thorne B, Maher CG. Do not routinely imaging for
uncomplicated low back pain. BJM. 2021 PMID:33579691; PMCID: PMC8023332
Jensen R K, Kongsted A, Kjaer P, Koes B. Diagnosis, and treatment of
sciatica BMJ 2019; 367 :l6273 doi:10.1136/bmj.l6273
Pesonen, J., Shacklock, M., Suomalainen, J. S., Karttunen, L., Mäki, J., Airaksinen, O., &
Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of
sciatica: validity and diagnostic performance with reference to the magnetic resonance
imaging. BMC musculoskeletal disorders, 22(1), 808. https://doi.org/10.1186/s12891-02104649-zLinks to an external site.
Professional, C. C. medical. (2023). Spondylolisthesis: What is it, causes, symptoms &
treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10302spondylolisthesis#What%20Is%20Spondylolisthesis?
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2) Post by: Ed Bayi
Patient Information: Age: 42 Gender: Male
Chief Complaint: Lower back pain with radiating left leg discomfort.
History of Present Illness: The patient, a 42-year-old man, has been complaining of
lower back discomfort for the last month and has decided to visit a doctor about it. He
claims that sometimes, the discomfort travels down his left leg. The patient describes the
discomfort as ongoing and says that it has considerably decreased both his daily
activities and quality of life. He reports pain is worsened by physical activity and relieved
by resting. He reports the pain shooting down his leg and pain scale as of now 3/10. He
has been taking Tylenol 650 mg for the pain and reports minimal relief. He denies fever,
flank pain, denies nausea or vomiting. He denies having anxiety or depression.
Medications: Tylenol 650 mg twice a day OTC for pain
Allergies: No known drug allergies, no food allergies, denies latex and environmental
allergies.
Past Medical History (PMH): HTN.
Past Surgical History (PSH): Denies prior surgical procedures.
Sexual/Reproductive History: Declines to discuss.
Personal/Social History: The patient reveals that his job title is office manager. Denies
smoking or use of illicit drugs. Drinks a little beer now and again. His present medical
state is not related to any previous trauma or injury.
Health Maintenance: Walks two to three days a week. Tries to have a healthy diet.
Immunization History: Immunizations are up to date based on recommended agerelated protocols.
Significant Family History: No noteworthy family history of conditions pertinent to the
patient’s present complaint exists.
Review of Systems:
General: The patient denies experiencing any generalized symptoms such as fever,
unintentional weight loss, or fatigue. There are no constitutional symptoms.
HEENT (Head, Eyes, Ears, Nose, Throat): Denies specific symptoms related to the head,
eyes, ears, nose, or throat. Denies headaches, visual disturbances, hearing problems,
sinus congestion, or sore throat.
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Respiratory: There are no complaints or signs of respiratory symptoms. Denies cough,
shortness of breath, wheezing, or chest pain.
Cardiovascular/Peripheral Vascular: Denies any cardiovascular or peripheral vascular
symptoms. Denies chest pain, palpitations, leg swelling, or changes in skin color or
temperature in the extremities.
Gastrointestinal: Denies abdominal pain, nausea, vomiting, diarrhea, constipation, or
changes in bowel habits.
Genitourinary: Denies urinary frequency, urgency, dysuria, hematuria, or changes in
urine color or odor.
Musculoskeletal: Reports lower back pain, which he describes as radiating to the left leg.
He does not complain of any other musculoskeletal issues such as joint pain, muscle
weakness, or limited range of motion in other parts of the body.
Neurological: Apart from the pain radiating to the left leg, there are no neurological
symptoms reported. No headache, dizziness, syncope, paralysis, ataxia, numbness or
tingling in the extremities. No change in bowel or bladder control.
Psychiatric: He denies symptoms related to mood, cognition, anxiety, or other mental
health concerns.
Skin/Hair/Nails: Denies specific symptoms or abnormalities related to the skin, hair, or
nails. Denies rashes, itching, hair loss, or changes in nail color or texture.
OBJECTIVE DATA:
Physical Exam:
•
Vital signs: Temp 98.0, Pulse 87, Resp 18, Bp 132/78
General: Alert and oriented, in no acute distress
HEENT: No abnormalities noted.
Neck: Supple, No stiffness or masses
Chest/Lungs: Clear to auscultation
Heart/Peripheral Vascular: Regular rate and rhythm, no murmurs
Abdomen: Soft, non-tender, no masses or organomegaly, norm active bowel sounds in
all 4 quadrants.
Genital/Rectal: Examination not relevant to the chief complaint
Musculoskeletal: Tenderness noted in the lumbar region; limited range of motion in the
lumbar spine; pain on straight leg raising test on the left leg.
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Neurological: Normal motor strength and sensory function in upper and lower
extremities; deep tendon reflexes are intact.
Skin: No rashes, lesions, or abnormalities noted.
Diagnostic Results:
Complete Blood Count (CBC): Hemoglobin: 14.2 g/dL, Hematocrit: 42%
ASSESSMENT:
Differential Diagnoses:
1. Lumbar Disc Herniation: The manifestation of lower back discomfort that
extends to the left leg in the patient is strongly suggestive of lumbar disc
herniation. The problem arises when the nucleus pulposus, which is the
gelatinous core of an intervertebral disc, protrudes beyond the annulus
fibrosus, the outer ring of the disc. This protrusion can exert pressure on
adjacent nerves, resulting in symptoms such as leg discomfort, numbness, or
muscular weakness (Jiang et al., 2022). Lumbar disc herniation may arise due
to a range of circumstances, including age-related degeneration, traumatic
incidents, or the exertion of excessive force during the lifting of substantial
things. The manifestation of pain that extends down the leg, sometimes
accompanied by sensations of tingling or weakness, is a characteristic
indication of this medical disease. The confirmation of this diagnosis
necessitates a comprehensive physical examination and the use of imaging
procedures, such as magnetic resonance imaging (MRI).
2. Sciatica: The occurrence of pain in the left leg may be ascribed to sciatica, a
medical ailment often resulting from the compression or irritation of the
sciatic nerve, which originates from the lumbar region and runs distally down
the lower extremity. The symptomatology, including sharp pain, tingling
sensations, and loss of sensation, aligns with the patient’s reported discomfort
(Jungen et al., 2019). Sciatica often manifests as a clinical manifestation of an
underlying etiology, such as a herniated intervertebral disc or spinal stenosis.
The diagnostic procedure will include the identification of the underlying
etiology of sciatic nerve compression by a comprehensive physical
examination and, if necessary, the use of imaging modalities.
3. Muscular Strain: The potential association between the patient’s profession as
a forklift operator and the development of lower back discomfort resulting
from muscle tension or overuse should not be disregarded. Muscular strain
often serves as a prevalent etiological factor for the onset of acute low back
pain, frequently arising from tasks involving lifting or repeated motions (Shaikh
et al., 2021). The potential validity of this diagnosis may be substantiated by
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the presence of discomfort in the muscle under consideration, as well as the
patient’s work, which entails engaging in physically strenuous activities. In
order to exclude other underlying illnesses, it may be necessary to use
diagnostic techniques such as X-rays or MRI.
4. Spinal Stenosis: The patient’s reported discomfort, which intensifies while
assuming an upright position or engaging in ambulation, corresponds with the
possible diagnosis of spinal stenosis. Spinal stenosis is characterized by the
constriction of the spinal canal, often attributable to degenerative alterations
or structural irregularities. The condition has the potential to exert pressure on
the spinal cord or nerve roots, hence causing back pain and leg discomfort,
particularly while engaging in weight-bearing activities (Lee et al., 2020).
Accurate diagnosis and effective distinction from other disorders, such as disc
herniation, are crucial for the implementation of personalized treatment
strategies.
5. Spondylolisthesis: Spondylolisthesis is a plausible etiology for the patient’s
lumbar pain and accompanying leg discomfort. The issue pertains to the
anterior displacement of a vertebra in relation to another, which may lead to
the compression of nerves and the subsequent manifestation of
accompanying symptoms. According to Chan et al. (2023), individuals may
encounter symptoms such as lumbar discomfort, leg pain that spreads, and a
decline in muscular strength. The precise identification and classification of
spondylolisthesis are of utmost importance in order to establish the most
suitable course of therapy, which may vary from conservative measures to
surgical procedures.
Probable Diagnosis:
Based on a comprehensive evaluation including the patient’s medical records, clinical
manifestation, and diagnostic findings, it is very likely that the diagnosis for this 42-yearold male who exhibits lower back pain that extends to the left leg is a lumbar disc
herniation. The patient’s account of persistent pain that sometimes radiates to the leg
provides corroborating evidence for the diagnosis of lumbar disc herniation, since it is
consistent with the characteristic symptoms associated with this condition. The disorder
arises when the central nucleus pulposus of an intervertebral disc herniates through its
annulus fibrosus, possibly causing compression of adjacent nerves, notably the sciatic
nerve, resulting in symptoms such as pain, paresthesia, dysesthesia, and myasthenia (Yu
et al., 2022). Several other possible diagnoses, such as sciatica, muscle strain, spinal
stenosis, and spondylolisthesis, were taken into account owing to the presence of similar
symptoms. Nevertheless, based on the comprehensive patient history and clinical
examination, lumbar disc herniation emerges as the most probable etiology. Additional
diagnostic imaging, such as magnetic resonance imaging (MRI), may be required to
validate the diagnosis and assess the magnitude of the disc herniation, thereby informing
the formulation of an appropriate treatment strategy (Chu et al., 2021). The chosen
course of action may encompass conservative measures or surgical intervention,
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contingent upon the severity of the condition and its impact on the patient’s daily
functioning.
Nerves Affected: Within the field of anatomy, it is important to ascertain the precise
nerve roots that are involved in this illness. The symptoms mentioned suggest potential
involvement of lumbar nerve roots, notably L4-L5 and L5-S1. The involvement of the L4L5 nerve root may present as pain that extends to the anterior aspect of the thigh, while
involvement of the L5-S1 nerve root may lead to pain that radiates to the posterior
aspect of the leg and further extends into the foot (Chu et al., 2021).
The evaluation of nerve root involvement necessitates the use of certain diagnostic
examinations. The Straight Leg Raise (SLR) test is a core diagnostic tool used to check
the status of the L5 and S1 nerve roots. During the examination, the patient assumes a
supine position, with one leg elevated while maintaining knee extension. If the individual
has discomfort that extends into the leg at an angle of less than 60 degrees, it indicates
the potential involvement of the nerve root. In addition, the use of the Femoral Nerve
Stretch Test may be performed as a means to evaluate the status of the L4 nerve root.
During the examination, the patient assumes a supine position while the leg is stretched.
The presence of pain experienced during leg elevation might potentially suggest the
involvement of the L4 nerve root.
The precise identification of the nerve roots implicated holds significant importance,
alongside the exploration of other symptoms that may be linked. This entails examining
the occurrence of numbness and tingling, as well as assessing the pattern and intensity
of sensory impairments in the lower extremity. It is important to evaluate muscular
weakness, paying particular attention to the specific muscle groups that are impacted.
Furthermore, it is essential to inquire with the patient on any instances of urinary or fecal
incontinence (Yu et al., 2022). The presence of this symptom may serve as a noteworthy
indicator, since it has the potential to indicate a more serious condition such as cauda
equina syndrome, necessitating prompt medical intervention.
The performance of a thorough physical examination is of utmost importance in order to
arrive at an accurate diagnosis. The comprehensive evaluation should include a
neurological assessment aimed at appraising the motor strength, reflexes, and feeling in
the lower limbs. In order to identify discomfort or muscular spasms, it is essential to do
palpation on the spine, muscles, and paraspinal regions. The evaluation of the patient’s
capacity to flex, extend, and rotate the lumbar spine is crucial, necessitating the use of
range of motion tests. In addition, it is recommended to do specific exercises, such as the
Straight Leg Raise Test and the Cross-Straight Leg Raise Test (Yu et al., 2022). The latter
procedure entails elevating the contralateral (right) leg in order to simulate the
occurrence of radiating pain on the symptomatic (left) side, hence aiding in the detection
of nerve root compression.
In summary, a comprehensive assessment of nerve root involvement and related
symptoms is necessary to accurately diagnose the patient’s lower back pain with
radiating symptoms. In accordance with the standards set out by the Agency for
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Healthcare Research and Quality (AHRQ), it is essential to investigate a variety of
probable reasons and conduct a comprehensive physical examination, which may include
specialized testing, in order to arrive at a precise diagnosis and develop an effective
treatment strategy. Additional diagnostic imaging and meetings with specialized medical
professionals may be necessary to validate the diagnosis and develop an appropriate
treatment plan for the patient.
References
Chan, A. K., Bydon, M., Bisson, E. F., Glassman, S. D., Foley, K. T., Shaffrey, C. I., … &
Mummaneni, P. V. (2023). Minimally invasive versus open transforaminal lumbar
interbody fusion for grade I lumbar spondylolisthesis: 5-year follow-up from the
prospective multicenter Quality Outcomes Database registry. Neurosurgical focus, 54(1),
E2.
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.
Jiang, H. W., Chen, C. D., Zhan, B. S., Wang, Y. L., Tang, P., & Jiang, X. S. (2022).
Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar
discectomy in the treatment of lumbar disc herniation: a retrospective study. Journal of
Orthopaedic Surgery and Research, 17(1), 30.
Jungen, M. J., Ter Meulen, B. C., Van Osch, T., Weinstein, H. C., & Ostelo, R. W. (2019).
Inflammatory biomarkers in patients with sciatica: a systematic review. BMC
musculoskeletal disorders, 20, 1-9.
Lee, B. H., Moon, S. H., Suk, K. S., Kim, H. S., Yang, J. H., & Lee, H. M. (2020). Lumbar
spinal stenosis: pathophysiology and treatment principle: a narrative review. Asian Spine
Journal, 14(5), 682.
Shaikh, S., Siddiqui, A. A., Alshammary, F., Amin, J., & Agwan, M. A. S. (2021).
Musculoskeletal disorders among healthcare workers: prevalence and risk factors in the
Arab World. Handbook of Healthcare in the Arab World, 2899-2937.
Yu, P., Mao, F., Chen, J., Ma, X., Dai, Y., Liu, G., … & Liu, J. (2022). Characteristics and
mechanisms of resorption in lumbar disc herniation. Arthritis Research & Therapy, 24(1),
205.
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LEARNING RESOURCES
Required Readings
•
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2023). Seidel’s guide to physical examination: An interprofessional approach (10th
ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 6, “Vital Signs and Pain Assessment” (Previously read in
Week 6)
o Chapter 22, “Musculoskeletal System”
This chapter describes the process of assessing the musculoskeletal
system. In addition, the authors explore the anatomy and
physiology of the musculoskeletal system.
•
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment
and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition
by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by
permission of Mosby via the Copyright Clearance Center.
o Chapter 22, “Lower Extremity Limb Pain”Download Chapter 22,
•
•
•
“Lower Extremity Limb Pain”
This chapter outlines how to take a focused history and perform a
physical exam to determine the cause of limb pain. It includes a
discussion of the most common tests used to assess
musculoskeletal disorders.
o Chapter 24, “Low Back Pain (Acute)” Download Chapter 24, “Low
Back Pain (Acute)”The focus of this chapter is the identification of
the causes of lower back pain. It includes suggested physical exams
and potential diagnoses.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA:
F. A. Davis.
o Chapter 2, “The Comprehensive History and Physical Exam”
(“Muscle Strength Grading”) (Previously read in Weeks 1, 2, 3, 4,
and 5)
o Chapter 3, “SOAP Notes”
This section explains the procedural knowledge needed to perform
musculoskeletal procedures.
Document: Episodic/Focused SOAP Note Exemplar (Word
document)Download Episodic/Focused SOAP Note Exemplar (Word
document)
Document: Episodic/Focused SOAP Note Template (Word
document)Download Episodic/Focused SOAP Note Template (Word
document)
14
Required Media
Musculoskeletal System – Week 8 (12m)
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s resources, it is highly recommended that you access and view
the resources included with the course text, Seidel’s Guide to Physical Examination. Focus
on the videos and animations in Chapter 21 that relate to the assessment of the
musculoskeletal system. Refer to the Week 4 Learning Resources area for access
instructions on https://evolve.elsevier.com/Links to an external site.
•
Marquis, P. (2019, April 4). Orthopedic knee evaluation with Paul Marquis
PT [Video].Links to an external
site. YouTube. https://www.youtube.com/watch?v=YVx4BepjjiY&feature=yo
utu.be
Optional Resources
•
•
•
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic
examination (11th ed.). New York, NY: McGraw Hill Medical.
o Chapter 13, “The Spine, Pelvis, and Extremities”
In this chapter, the authors explain the physiology of the spine,
pelvis, and extremities. The chapter also describes how to examine
the spine, pelvis, and extremities.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P.,
Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., Maher, C. G.,
Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G.,
Underwood, M., van Tulder, M., . . . Woolf, A. (2018). Prevention and
treatment of low back pain: evidence, challenges, and promising
directions.Links to an external site. The Lancet, 391(10137), 2368–2383.
https://doi.org/10.1016/s0140-6736(18)30489-6
Hicks, C., Levinger, P., Menant, J. C., Lord, S. R., Sachdev, P. S., Brodaty, H., &
Sturnieks, D. L. (2020). Reduced strength, poor balance and concern about
falls mediate the relationship between knee pain and fall risk in older
people.Links to an external site. BMC Geriatrics, 20(1), 94.
https://doi.org/10.1186/s12877-020-1487-2
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