CC
Low back pain.
History of spina bifida and back surgery.
S
The patient is a 32-year-old female who was born with spina bifida. She had surgery as an infant. She also had subsequent surgery when she was a teenager. Since that time, however, she states she has not had issues related to this, other than that she has to self-catheterize. She is followed by a urologist for this. She tells me that she does intermittently get some low back pain. She did start getting her usual low back pain this past Monday. Yesterday, she worked a full day as a bridal stylist. She does need to stand throughout most of the day. By 7:30 at night, she states she was leaning over on the counter at work and had onset of severe pain in her low back, to the
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Pulse 80. Respiratory rate 12. Weight 136 pounds, which is very stable for patient.
General
The patient is alert, oriented, no acute distress, she is sitting upright in her chair, however.
Musculoskeletal
Back with no tenderness over her kidney area. She does have a scar in her low back. Scar is surrounded by some blotchy redness, but the patient states this always looks like this. She does have pain to palpation above the scarred area and her low back. She has decreased range of motion of her low back, in general. Flexion however, causes significant pain and she is reluctant to do this. She has no pain when flexing her neck.
Extremities
Negative straight leg raise bilaterally, good range of motion at her hips. She does have pain when flexing both hips while in a lying position.
Neurologic
Deep tendon reflexes 2+ patellar and equal, 1+ Achilles and equal. Sensation is intact to crude touch.
A/P
Low back pain, severe spasm yesterday that lasted for a short period of time. My suspicion is this is related to fatigue of her musculature with a spasm. She does, however, have a significant history with her back as detailed above. At this point, however, we will have her try heat alternating with ice. We will have her use Aleve two tablets p.o. b.i.d. to take with food. She will do slow stretches. If symptoms are worsening or not improving, we may need to pursue an MRI of her back. Otherwise, she will let us know how things are
Achilles tendinopathy and its contributing pathologies has been a heavily researched topic throughout multiple professions. Although a unified consensus and classification on the underlying pathology is yet to be reached, a shift from the term tendinitis to tendinosis has slowly been adopted, and is now believed to follow a continuum. Previous incorrect belief of an inflammatory pathophysiology has lead to the development of treatment options that are inappropriate and unsuccessful, leaving the tendon unable to adequately heal or strengthen increasing its risk of repetitive re-injury and the development of chronic Achilles tendinopathy. As a result an understanding of the pathophysiology, its effect on lower limb function and biomechanical risk factors contributing to the development of Achilles tendinopathy need to be considered when developing a rehabilitation program to coincide with new research and to address the underlying degeneration and failed healing of the tendon.
The patient is a 45 year old male who was in a car accident that
She has her right leg bent with her knee always in the air and her left foot is
relaxed and indicated that she had no pain prior to her discharge to the ward.
Currently, I am involved in a prospective cohort study with other colleagues from King Fahad Medical City that aims to study the effect of a low back care educational program on low back pain prevalence among health-care professionals.
A patient, waiting to undergo his cardiac surgery, is lying on a surgical platform. An
On 1/9/18 I met Ms. Hendrick at the office of Dr. Kala, Neurologist. Ms. Hendrick reports that she had just left the lab having a repeat kidney function lab value drawn. She will find out when the values are available if she is able to have the port removed from her chest and confirm that she is not going to need more dialysis. Ms. Hendrick said she has a constant headache now. Her face still becomes numb on the right and the pain is mainly on the right side of her head. The best the pain level gets is a 5 and the worst is an 8. Now that she is limited to medications she doesn’t seem to be able to break the cycle. She reports that the Sumatriptan was not approved so she did not have that to take. Ms. Hendrick also gave me a bill that was from an MRI done ordered by Dr. Saper. I have enclosed a copy for the adjuster. All medications were reviewed; many have been stopped due to the kidney function. She no longer takes Neurontin, Lyrica, and Metformin. She will need approval by the Nephrologists before she can resume them. She does however still need the Sumatriptan injections. At this point, Dr. Kala recommends getting clearance from the Nephrologists to resume treatment with Dr. Saper. Ms. Hendrick will proceed with getting that clearance.
The patient tells me this pain started just a couple of days ago on Wednesday evening. She said that it started in the left side of her back. Since then, it seems to move around the side and into her left lower abdomen, pelvis area, and right over the bladder where she feels a lot of pressure and pain. She has a history of sciatica on the left side and initially thought this just might be her sciatica type pain. However, the fact that it has radiated to the front is very different from the sciatica pain she has had in the past, which is what prompted her to seek care. When it initially happened, she was feeling nausea, but that has resolved. She
Review of claimant’s stated pain/limitations: He rates it as a 7 at best and up to a 10. Mr. Anderson said the pain interferes with all aspects of his life. It affects his sleep. Mr. Anderson said any activity increases back
Jackson, M.A. & Simpson, K. H. (2006). Chronic Back Pain. Continuing Education in Anaethesia, Critical Care and Pain, 6(4), 152-155. http://dx.doi: 10.1093/bjaceaccp/mkl029
The patient was transferred into my care via the Emergency Assessment Unit for Surgical Patients (EAUS). I was given handover by the charge nurse who has already pre-a...
Resident maintained functional ROM /strength in the in key upper and lower extremity joints and muscle groups. Bilateral knee extension lag approximately -10 degrees. Bilateral hamstrings and calf muscle tightness noted. Right shoulder muscle strength maintained at 3+/5, Rest of the muscle groups in the upper extremity maintained strength 4/5 and 4-/5 in the bilateral lower extremities. She has good sitting balance, decreased standing and walking balance. Resident transfers safely with 2 person assist (pivot) using walker. Resident able to walk short distances with
She also had stiffness in her upper back and neck due to two motor vehicle accidents in 2010 and 2012, though the pain in the buttocks and legs was the pain she wished to have focused on. The patient had previously had Bell’s palsy in 1989 and 1994, as well as two c-sections in October 2000 and February 2002. Her activity level as described as moderate to low. She had also broken 3 fingers, one during the treatment term, and a broken toe. The only supplement or medication the patient reported taking was vitamin d. The patient did not see a doctor in regards to the pain in her gluteal region, nor had she had any formal treatments done to help alleviate the pain, though she had had her husband massage the
After the handover, I was asked by my mentor to attend to a patient who is bed ridden to have her personal care done with the assistance of one of the health care assistant staff. The patient was recently admitted to the ward and she looks sc...
I was assigned to patient B.P. She was admitted on September 6th from RMC. Her admitting diagnoses are acute embolism and thrombosis of unspecified deep veins of lower extremities; Unspecified Dementia without behavioral disturbance; Major Depressive Disorder, Single episode; Intervertebral Disc Degeneration, Lumbar region; Essential hypertension; Vitamin Deficiency, Dorsalgia, and pain. She had two patches covering wounds on forearms bilaterally. There was an order in her chart for occupational therapy and physical therapy, but interacting with her throughout the day, I wonder how often she accomplishes it. They also have behavioral monitoring and side effect evaluation of the psychotropic medications she is taking. B.P seemed very confused through the whole day. In the morning I went in and introduced myself and asked her some questions to evaluate her mental status and she immediately brought up her headache. I asked her if she knew where she was and she was unable to answer that along with what the date was. Clarissa then helped me change her depends and she was able to