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Discussion: Assessing Musculoskeletal Pain, Case 3: Knee Pain

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Discussion: Assessing Musculoskeletal Pain, Case 3: Knee Pain

In the case study that has been presented, a 53-year-old patient experiences dull pain in both knees. Also, at times the patient also experiences one or both knees click and he also describes a catching sensation under the patella. In this regard, this paper examines various questions associated with this case.

In determining the causes of the knee pain, what additional history do you need?

At first, there is a need for obtaining information on any past hospitalizations and illness as well as the medications that the patient may be taking. Also, one has to obtain information on significant issues such as past surgery and injury to the knee. With this information, it will be possible to determine whether the patient condition is caused by an underlying medical condition or a condition that has recently been acquired.

What categories can you use to differentiate knee pain?

There exist various reasons that can cause knee pain. Based on these reasons, the following categories can be used to determine the kind of pain that is underlying.

  • Acute Injury- This type of pain occurs as a result of chronic injury to the knee that may cause a broken bone, minuscular tear, or a torn ligament.
  • Medical conditions- Knee pain can also be caused by medical conditions such as infections, osteoarthritis, and rheumatoid arthritis.
  • Chronic use/over use conditions- This occurs due to repetitive use and it involves conditions such as bursitis, osteoarthritis, patellar syndromes, and IT band syndrome among others (Balentine, 2019).

What are your specific differential diagnoses for knee pain?

The following are some of the conditions that can be considered for diagnosis.

  1. Patellofemoral pain syndrome- This is a condition that causes dull and aching pain in front of the knee and which arises due to muscle weakness and overuse that can be caused by activities such as running (Nall, 2017).
  2. Rheumatoid arthritis- This is a condition that causes joint pain and damage throughout the body. With this condition, if a joint is affected in one arm or leg, the same joint is also affected in the other part (Holland, 2019).
  3. Osteoarthritis- This condition arises due to the deterioration of the joint that cushions the end of bones in joints such as the knee thus causing pain (Holland, 2019)
  4. Bursitis- This condition occurs due to inflammation that is caused by the overuse of the knee (Mayo Clinic, 2019).
  5. Patellar tendinitis- This is the inflammation and irritation of tendons that joins muscles to joints which causes pain (Mayo Clinic, 2019).

What physical examination will you perform?

At first, there will be a need to examine the knee for redness, skin changes, swelling, and any form of deformity. The next step is to palpate the knee for any form of swelling, sensation, tenderness, blood flow, warmth or coolness. The third step is to test the knee for range of motions that will make it possible to listen to any sounds that may be produced. Based on this examination, as the patient moves their knees, one will listen for any clicking, popping, or grinding sounds (Kaiserpermanente, 2019).

What anatomic structures are you assessing as part of the physical examination?

When evaluating the knees, there are various parts that have to palpated. They include the joint lines, the patella, proximal fibula, tibial tuberosity, Gerdy’s tubercle, and the tibial plateau. By examining these parts, it will be possible to determine the parts that are affected which is key in determining the specific condition that is underlying.

What special maneuvers will you perform?

Some of the special maneuvers that can be performed in this case include; valgus and varus tests, posterior drawer test, Lachman test, and the anterior drawer tests. With these tests that are performed when the patient is lying on the table, the doctor is able to examine the ligaments in the knee. The McMurray that is also performed when the patient is lying down can also be conducted where the doctor bends the knee while holding it on the foot and while pressing on the knee (Kaiserpermanente, 2019). This way, it is possible to determine whether the menisci is damaged. By combining these tests with physical examination, it is possible to determine the condition that affects the patient.

References

Balentine, J. R. (2019). Knee pain treatment, diagnosis & related symptoms. MedicineNet. https://www.medicinenet.com/knee_pain_facts/article.htm

Holland, K. (2019). Chronic knee pain: Causes, symptoms, and diagnosis. Healthline. https://www.healthline.com/health/chronic-knee-pain#risk-factors

Kaiserpermanente. (2019). Physical examination of the knee. Kaiser Permanente Washington. https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=hw28334

Mayo Clinic. (2019, March 7). Knee pain – Symptoms and causes. 20350849“>https://www.mayoclinic.org/diseases-conditions/knee-pain/symptoms-causes/syc-20350849

Nall, R. (2017). Patellofemoral syndrome symptoms, exercises, and treatment. Healthline. https://www.healthline.com/health/patellofemoral-syndrome

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