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

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.

Learning Objectives

Students will:

• 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

Ischemic stroke

https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke

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.

To prepare:

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

Pathophysiologic Processes

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.

References

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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FAQs
Neurological and musculoskeletal disorders

Neurological disorders are conditions that affect the brain, spinal cord, and nerves. These can include diseases such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, epilepsy, and migraines. Neurological disorders can cause a wide range of symptoms, including changes in sensation, movement, and cognitive function.

Musculoskeletal disorders, on the other hand, are conditions that affect the muscles, bones, joints, and connective tissues of the body. These can include conditions such as arthritis, osteoporosis, back pain, and sports injuries. Musculoskeletal disorders can cause pain, stiffness, and limited range of motion.

While neurological and musculoskeletal disorders affect different parts of the body, they can often be interconnected. For example, some neurological disorders such as Parkinson’s disease can lead to musculoskeletal problems such as stiffness and reduced mobility. Additionally, musculoskeletal conditions such as back pain can sometimes be caused by nerve compression or other neurological factors.

Musculoskeletal system

The musculoskeletal system is the combination of the muscular and skeletal systems of the body. It is responsible for providing structure, support, and movement to the body.

The skeletal system consists of bones, cartilage, and ligaments. The bones provide the framework for the body and protect the internal organs. The cartilage cushions the joints and provides flexibility, while the ligaments connect bones to other bones and provide stability to the joints.

The muscular system consists of muscles and tendons. The muscles are responsible for generating force and movement, while the tendons connect muscles to bones, allowing for the transfer of force from muscle to bone.

Together, the musculoskeletal system allows the body to move and perform a wide range of activities, from simple movements like walking and standing, to more complex movements like running, jumping, and lifting heavy objects. The system also plays a crucial role in supporting the body’s weight and protecting vital organs.

Neurological and musculoskeletal pathophysiologic processes of parkinson disease

Parkinson’s disease is a progressive neurological disorder that affects movement and motor function. The exact cause of the disease is not fully understood, but it is believed to be caused by a combination of genetic and environmental factors. Parkinson’s disease is characterized by the gradual loss of dopamine-producing cells in the brain, which leads to a decrease in dopamine levels and a disruption of the communication between the brain and the muscles.

Neurological Pathophysiology of Parkinson’s Disease:

The loss of dopamine-producing cells in the brain is the primary neurological pathophysiology of Parkinson’s disease. Dopamine is a neurotransmitter that plays a crucial role in the regulation of movement and motor function. When dopamine levels in the brain decrease, it leads to a disruption of the communication between the brain and the muscles, resulting in the movement problems that are characteristic of Parkinson’s disease.

The loss of dopamine-producing cells in Parkinson’s disease is thought to be caused by the accumulation of abnormal protein deposits called Lewy bodies. These Lewy bodies are believed to interfere with the normal functioning of the dopamine-producing cells, leading to their degeneration and death.

Musculoskeletal Pathophysiology of Parkinson’s Disease:

The musculoskeletal pathophysiology of Parkinson’s disease is characterized by a range of motor symptoms, including tremors, rigidity, and bradykinesia (slowness of movement). These symptoms are caused by a combination of the neurological changes described above and the progressive degeneration of the musculoskeletal system.

The loss of dopamine-producing cells in the brain leads to a decrease in dopamine levels, which in turn leads to a disruption of the communication between the brain and the muscles. This disruption results in the characteristic tremors and rigidity that are associated with Parkinson’s disease.

The progressive degeneration of the musculoskeletal system in Parkinson’s disease can also lead to postural instability and gait difficulties. As the disease progresses, patients may experience a loss of balance and coordination, making it difficult to walk and carry out daily activities.

In summary, Parkinson’s disease is a complex disorder that involves a range of neurological and musculoskeletal pathophysiological processes. The loss of dopamine-producing cells in the brain is the primary neurological pathology, leading to disruptions in communication between the brain and the muscles. This disruption, combined with progressive degeneration of the musculoskeletal system, leads to the characteristic motor symptoms associated with the disease.

How does ethnicity affect health care?

Ethnicity can have a significant impact on health care. Here are some of the ways that ethnicity can affect healthcare:

1. Health disparities: Ethnicity can be a factor in health disparities, which are differences in health outcomes between different groups. For example, some ethnic groups may have higher rates of certain diseases or conditions, such as heart disease or diabetes, which can affect the type and quality of healthcare they receive.
2. Cultural beliefs and practices: Ethnicity can also influence cultural beliefs and practices related to health and healthcare. For example, some ethnic groups may prefer traditional or alternative medicine over Western medicine, or may have certain dietary restrictions or preferences that need to be taken into account when developing a treatment plan.
3. Language barriers: Language can also be a significant barrier to healthcare for people from certain ethnic groups. If a patient doesn’t speak the same language as their healthcare provider, it can be difficult to communicate effectively about their symptoms, medical history, and treatment options.
4. Access to healthcare: Ethnicity can also affect access to healthcare. For example, people from certain ethnic groups may be more likely to live in areas with limited healthcare resources or to lack health insurance, which can make it more difficult to access care.
5. Discrimination and bias: Ethnicity can also play a role in discrimination and bias in healthcare. Patients may experience discrimination or bias from healthcare providers based on their ethnicity, which can impact the quality of care they receive.

How does ethnicity affect health inequalities

Ethnicity can be a significant factor in health inequalities, which are differences in health outcomes between different groups. Here are some of the ways that ethnicity can affect health inequalities:

1. Social determinants of health: Ethnicity can be linked to social determinants of health, which are the social, economic, and environmental factors that can impact health outcomes. For example, people from certain ethnic groups may be more likely to live in areas with poor air quality, inadequate housing, or limited access to healthy food, which can contribute to poor health outcomes.
2. Access to healthcare: Ethnicity can also affect access to healthcare, which can impact health outcomes. People from certain ethnic groups may be more likely to lack health insurance, have limited access to healthcare facilities, or face language barriers that make it difficult to access care. This can lead to delays in diagnosis and treatment, as well as worse health outcomes.
3. Cultural factors: Ethnicity can also influence cultural factors that impact health outcomes. For example, some ethnic groups may have different cultural attitudes towards health and illness, which can affect their willingness to seek medical care or follow treatment plans. They may also have different cultural beliefs about the causes of disease or the role of healthcare providers, which can impact their interactions with the healthcare system.
4. Discrimination and bias: Ethnicity can also be a factor in discrimination and bias, which can impact health outcomes. Patients from certain ethnic groups may experience discrimination or bias from healthcare providers, which can lead to disparities in the quality of care they receive. This can include biases related to language, cultural differences, or unconscious biases related to race or ethnicity.
5. Health behaviors: Finally, ethnicity can be linked to health behaviors, such as smoking, alcohol consumption, and physical activity levels, which can impact health outcomes. People from certain ethnic groups may be more likely to engage in behaviors that increase their risk of certain health conditions, such as heart disease or cancer.

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