A 58-year-old obese white male presents to ED with chief
Concepts of Neurological and Musculoskeletal Disorders – Part 2
As homeowners know all too well, there is a continuous need for maintenance and repair. Some efforts are precautionary in nature, while others are the result of issues that surface over time.
Similarly, musculoskeletal disorders can develop over time. For some disorders, such as osteoporosis, precautionary treatments are a potential option. But much like issues that surface in a home over time, many musculoskeletal issues can be very serious concerns, and they can have a significant impact on patients’ lives.
This week, you continue to examine fundamental concepts of neurological and musculoskeletal disorders. You explore common disorders that impact these systems and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients.
- Analyze processes related to neurological and musculoskeletal disorders
- Identify racial/ethnic variables that may impact physiological functioning
- Evaluate the impact of patient characteristics on disorders and altered physiology
- McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Requiered Media:
Osteoporosis – causes, symptoms, diagnosis, treatment, pathology
Module 5 Assignment: Case Study Analysis
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.
Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Assignment (1- to 2-page case study analysis)
A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl
In your Case Study Analysis related to the scenario provided, explain the following:
- Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
Expert Answer and Explanation
Alteration of Neurological and Musculoskeletal Systems
According to Jung et al. (2017), the chills, fever, swelling, and pain in the right great toe are as a result of the inflammation of the musculoskeletal system in the toe area. The authors also note that different body structures, such as joints, tendons, muscles, nerves, and bones, tend to have various physio-pathological mechanisms behind the signs. One common alteration for most neurological and musculoskeletal conditions is the misalliance between the external load due to physical posture and exertion and the ability of the human body to hold the load. The frequency of the load and the duration are also so significant. Clark et al. (2017) note that the capacity to withhold the pressure exerted by the loads on muscles depends on gender, general health, and age. Pain is a neurological sensation and is a sign that a specific tissue in the body id damaged. All tissues, including the muscle tissues, have the pain-sensitive nerves. In this case, the pain was feeling pain because the nerve cells in the muscles sensed that there was high mechanical pressure on the inflamed muscles and joints (Clark et al., 2017). The patient cannot put weight on his foot because the nerves have sent the stimulus to the spinal cord, which orders the motors reflex to move away from the swollen foot.
Racial/Ethnic Variables that may Impact Physiological Functioning
A study done by Booker et al. (2019) aimed to understand the difference in muscle strength and lean mass in different ethnic groups. The authors found that there was higher lean mass among Hispanic and black ethnic men compared to white men. However, the researchers found that there were lower physical function levels among Hispanic and black men. As a result, Hispanic and African American people are more likely to suffer neurological and musculoskeletal conditions compared to white individuals. Another study done by El Khoudary et al. (2019) showed that African American subjects had greater strength and appendicular lean mass compared to white subjects. However, African American subjects had lower muscle quality than white participants. This study concluded that African American people have higher BMI compared to whites because of their lower muscle quality. Fujishiro et al. (2017) did a study and found that black women have higher bone and skeletal mass compared to white women. The study also found that there were higher levels of serum testosterone in African American women compared to white women.
How the Processes Interact to Affect the Patient
The patient is a white male, and this means that he has high levels of physical functioning. El Khoudary et al. (2019) note that high physical functioning can help reduce the risks of suffering conditions, such as type 2 diabetes, arthritis, and hypertension. People recording high physical functioning can suffer muscle or joint injury that can cause pain and inflammation on the tissues around the affected muscle. Being white, the patient has lower lean mass, muscle strength, skeletal mass, and bone mass. Therefore, he cannot withstand prolonged mechanical loading of the tendons. The patient’s obese weight is likely to exert pressure on his tendons hence causing pain and swollen toe muscle (Fujishiro et al., 2017). Overall, a person with higher BMI (obese) and lower skeletal muscle risk injuring his or her musculoskeletal muscles and developing conditions, such as arthritis.
Booker, S., Cardoso, J., Cruz-Almeida, Y., Sibille, K. T., Terry, E. L., Powell-Roach, K. L., … & Staud, R. (2019). Movement-evoked pain, physical function, and perceived stress: An observational study of ethnic/racial differences in aging non-Hispanic Blacks and non-Hispanic Whites with knee osteoarthritis. Experimental Gerontology, 124, 110622. https://doi.org/10.1016/j.exger.2019.05.011
Clark, J., Nijs, J., Yeowell, G., & Goodwin, P. C. (2017). What are the predictors of altered central pain modulation in chronic musculoskeletal pain populations? A Systematic review. Pain physician, 20(6), 487-500. Official URL: http://www.painphysicianjournal.com/
El Khoudary, S. R., Greendale, G., Crawford, S. L., Avis, N. E., Brooks, M. M., Thurston, R. C., … & Matthews, K. (2019). The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause (New York, NY), 26(10), 1213. doi: 10.1097/GME.0000000000001424
Fujishiro, K., Hajat, A., Landsbergis, P. A., Meyer, J. D., Schreiner, P. J., & Kaufman, J. D. (2017). Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors. SSM-population health, 3, 497-505. https://doi.org/10.1016/j.ssmph.2017.05.010
Jung, H., Kim, H. J., Kim, B. R., & Lim, D. (2017). Alterations of human responses by varying dynamic rotational perturbations on balance training equipment. International Journal of Precision Engineering and Manufacturing, 18(9), 1269-1274. https://link.springer.com/article/10.1007/s12541-017-0149-6
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