REASON
CHIEF COMPLAINT: Lower back pain.
HISTORY
The patient is a 47-year-old, African American male with a history of chronic lower back pain. The patient states that the pain is primarily at the level of the lower back, but on occasion, he will get radiating symptoms down both legs. Sometimes the right which seems to bother him the most, but also the left. He has tried physical therapy in the past and apparently has lost weight but the discomfort remains. He is currently complaining of numbness more so on the left than the right. The discomfort that bothers him the most is at the level of the back. The numbness and tingling that he feels is not always present but does become worse with any types of prolonged sitting. In the past,
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There is mild endplate osteophyte formation at L3-4 and L4-5 with mild disk narrowing at L4-5. There is multilevel leg apophyseal joint arthropathy present at L3-4, L4-5, and most severe at L5-S1. There is also a metallic bullet located in the soft tissues posteriorly in the lower portion of the left hemithorax.
PHYSICAL EXAMINATION
The examination shows that temperature was 98.1, BP 131/82, heart rate 78, respiration rate is 16. He is of increased weight for height. He weighs 216 pounds. Gait was not antalgic. He was able to go up on his heels and toes without difficulty. He was able to perform a full squat without too much difficulty. Single leg squats did not reveal any significant knee adduction on either the right or the left. Palpation at the level of the lower back revealed increased tenderness in the lower lumbar paraspinals and notably diminished muscularity in the lower lumbar paraspinals and upper gluteal musculature as well as the hip girdle muscles. Diminished muscularity in the abdominal region as well. Motor power in the lower extremities was at the 4+/5 both proximally and distally and this was bilaterally. The sensory examination was slightly diminished to pinprick on the left in the L4-L5 and possibly S1 dermatomal distribution when compared to the right. Reflexes were preserved at the knees and present but diminished at the ankles. Toes were downgoing. No upper motor or neuron track signs were noted. The straight leg raising maneuver was
There are approximately six types of EDS that have been distinguished but other types exist that are very uncommon. Classical, Hypermobile, Vascular, Kyphoscoliosis, Arthrochalasia, and Dermatosparaxis. Classical and Hypermobile make up over 90% of all reported cases of EDS. With the Classical type of EDS a person would have hyperextensible (stretchy) skin with widened atrophic scars and joint hypermobility. The skin is smooth and velvety with tissue fragility and easy brusability. Also evident are molluscoid pseudotumors (fleshy lesions associated with scars) frequently found over pressure points (e.g. elbows) and subcutaneous spheroids, which are commonly mobile and palpable on the forearms and shins. Complications of joint hypemobility include sprains, dislocation are common in the shoulder, patella and temporomandibular joints Muscle hypotonia and slower gross motor development also can occur It is inherited in an autosomal dominant manner (Clarke, D., Skrocki-Czerpak, K., Neumann-Potash, L.).
Fibrodysplasia ossificans progressiva also known as FOP is a one of the rarest, most disabling genetic bone conditions known to medicine. FOP causes muscles, tendons, ligaments, and other connective tissues to turn in to bone. Movement becomes limited in the affected areas of the body. People with FOP typically have malformed toes at birth, meaning the big toe is typically shorter than normal and abnormally turned outward in a position called a valgus deviation. Symptoms of FOP start to show up in early childhood. Most people with FOP develop painful tumor-like swellings also known as fibrous nodules. The fibrous nodules are visible on the neck, shoulders, and back.
Ooi, C., & Fraser, W. (1997). Paget's disease of bone. The Fellowship of Postgraduate Medicine, 73, 69-74. Retrieved June 12, 2010, from the PubMed database.
Osgood-Schlatter Disease or syndrome (OSD) is an irritation of the patellar ligament at the tibial tuberosity (Dhar). Osgood-Schlatter Disease is claimed by some to not actually be a disease (Sims). But is rather a collection of symptoms that involves the tibial tubercle epiphysis (Sims). Osgood-Schlatter Disease affects as many as 1 in 5 adolescent athletes (Diseases and Conditions: Osgood-Schlatter Disease). Some other common names for this disease are Osteochondrosis, Tibial Aponphysitis, Tibial Tubercle Apophyseal Traction Injury, Morbus Osgood- Schlatter, and Rugby Knee (Dhar). “This can cause multiple sub-acute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit (Dhar). Activities such as kneeling may irritate the tendon further (Dhar).”
Osteogenesis Imperfecta (OI), also called fragile bone ailment or Lobstein disorder, is an inherent bone issue portrayed by weak bones that are inclined to break effortlessly with practically zero cause. A arrangement of various sorts of OI is regularly used to depict how seriously a man with OI is affected.OI is brought on by hereditary deformities that influence the body's capacity to make solid bones. In predominant established OI, a man has too little sort I collagen or a low quality of sort I collagen because of a transformation in one of the sort I collagen qualities which makes the bones
What is scoliosis? Scoliosis is a musculoskeletal disorder that causes the back to curve sideways like and “S” or a “C” and cause the body to lean to one side. Scoliosis can eventually if not looked into and not treated colid with your bodily organs like your heart, lungs, and kidneys. This can cause you to slump down into a hump and cause it hard to breath and do physical activity.
“The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease” by Thomas A. Edison. Chiropractors use hands-on spinal manipulation and other alternative treatments on the spine which will enable the body to heal itself without surgery or medication. Chiropractic care began in 1895 when its founder, Daniel David Palmer, claimed any and all diseases could be healed by nothing more than just his hands. Dr. Palmer examined a janitor who was deaf for 17 years after the janitor felt his back was out of place, so Dr. Palmer gave an adjustment to what was felt to be a misplaced vertebra in the upper back. The janitor then observed that his hearing improved thanks to Dr. Palmer. Chiropractors use manipulation to restore mobility to joints restricted by tissue injury caused by sitting without proper back support. Chiropractic is primarily used as a pain relief alternative for muscles, joints, bones, and connective tissue, such as cartilage, ligaments, and tendons. About 22 million Americans visit chiropractors annually
It was noted that the patient has had increase range of motion and decrease in allodynia due to injection. The patient’s injection has worn off and is in more pain as well as decrease in range of motion noted due to not having the injection performed. It was also mentioned that the patient is doing self-therapy. Currently, the pain is rated as 6 with medication and as 8 if without medications. The pain is located at left knee and ankle. The patient describes it as aching and increased. Physical examination revealed that on palpation of the lumbar facet revealed pain on both the sides at L3-S1 region. There is palpable twitch positive trigger points are noted in the lumbar paraspinous muscles. Motor strength is grossly normal except pain inhibited 4/5 on the left foot eversion and plantar flexion. Examination of the extremity revealed mild increase swelling in ankle and in the 3rd/4th metatarsals. Left ankle reveals increase allodynia and hyperalgesia. Dorsiflexion is 10 degrees. Plantarflexion is 30 degrees. Subtalar joint inversion is 4 degrees secondary to pain. Inversion is 5 degrees, forefoot abduction is 10 degrees, abduction of 20
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning on urination, and decreased urine output for three days.
The patient is a 40-year-old male with chronic lower back pain and radicular symptomatology in the left lower extremity and then the right. The patient underwent epidural steroid injection therapy on 08/18/2016. The patient underwent a right L5-S1 and an S1 transforaminal ESI under fluoroscopic guidance. The patient states that he did fairly well after injection therapy up until 12/2016 when his symptoms began to come back though not nearly as intense as they were before. Previously, he was having the radicular complaints on a continuous basis. Currently, he states that he has the same type of symptoms but they are not present all the time. He also notes that his symptoms may have also gotten worse as a result of a recent urologic surgery that he underwent which required him to be lying on his back with his legs elevated for several hours until the procedure was completed. He currently denies any new changes with regards to his bowel or bladder function or increased pain with Valsalva-type maneuver. No recent fever or infection. No weight loss. No new constitutional symptoms.
Type IV of OI is much rarer, comprising only 5% of cases. The bones may appear normal at the time of the first...
The syndrome is caused because of Genetic mutation that replaces connective tissues (muscles) with bones when someone gets injured instead of getting cured. This results in a new skeletal structure. Unfortunately this syndrome does not have any cure and the patients are advised to always be careful and not to fall or have any kind of traumas. They can’t engage in any sports in order to prevent any injuries. Surgery for removal of extra bones is not an option because removal of bones will lead to ingrowth of more bones. From previous cases it is seen that most of the patients suffering from this condition do not live more than 40 years and they die of respiratory
Simple musculoskeletal back pain has symptoms of pain in the lumbrasacral area of the back (Jackson & Simpson, 2006). The upper thighs and knees are also known to be affected (Jackson & Simpson, 2006). This pain is usually described as a dull pain (Jackson & Simpson, 2006). Spinal nerve root pain is localised down the leg, and usually continues below the knee and into the feet (Jackson & Simpson, 2006). It has been d...
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
Musculoskeletal system: He doesn’t have any stiffness and swelling at any joints. He can walk normally and never had history of falls.