Case Scenario: EM is a 74 year old woman admitted into the hospital with a complaint of back pain. She states that she is unable to sit for extended periods of time. During her bouts of pain, her blood pressure
rises substantially. She is a telemetry patient on the floor and is on bed rest. The patient has a
history of Crohn's Disease and in 1997 underwent a sigmoid colon resection. She also has a
history of diverticulitis and COPD. Her final diagnosis consists of back pain related to
degenerative joint disease of the lumbrosacral spine as a result of osteoarthritis.
A. Description of the Disease - Osteoarthritis
Osteoarthritis, also known as degenerative arthritis can cause the breakdown of cartilage between the facet joints. The facet joints are located in the posterior spine. These facet joints consist of two opposing bony surfaces with cartilage in between them. There is a capsule of fluid that allows the joint to move without friction. When these fluids dissipate due to cartilage breakdown, joint movement becomes impaired and eventually, leads to bone against bone friction. Hence, the patient loses motion and as lose mobility, contributing to the onslaught of lower back pain.
B. Symptoms of Osteoarthritis
The primary clinical manifestations of OA are pain, stiffness and functional impairment of the affected joint. The pain in OA is due to an inflamed synovium, stretching of the joint capsule or ligaments, irritation of the nerve endings in the periosteum, tendinitis and muscle spasm. Stiffness is most common in the morning but generally lasts about 30 minutes or so. Functional impairment is based on pain upon movement and guarding, along with the limited m...
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Davis Publications, Philadelphia, PA; Reprint Edition 1999, pp. various within.
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Seventh Edition, J.B. Lippincott Company, Pennsylvania, 1992. pp. 1842- 1867.
Mayo Clinic for Education and Research, Osteoarthritis - A Self Care Guide, Online Source
Mayo Foundation, 1999. available 12/7/99. http://www.mayoclinic.org/9706/osteoart.htm
Spine Online, Advanced Outpatient Care for Sufferers of Osteoarthritis in the Lower Lumbar Region,
Online, Spine Sources Inc., 1999. Available 12/7/99. http://www.spineonline.com
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