Musculoskeletal Case Study: A 74-year-old female presents to the clinic with complaints of increased difficulty in getting up from a seated position and worsening right knee pain over the last few months.
Musculoskeletal Case Study: A 74-year-old female presents to the clinic with complaints of increased difficulty in getting up from a seated position and worsening right knee pain over the last few months.
Musculoskeletal Case Study
This paper is an analysis of a case study involving a 74-year-old patient. The patient came with complaints of increased difficulty in getting up from a seated position and worsening right knee pain over the past few months. The knee pain aches at night when she tries to rest and sharp when at rest. The patient has a history of diabetes and type 2 hypertension. A diagnosis of osteoarthritis has been made. Therefore, the paper examines the musculoskeletal pathophysiologic processes accounting for the presenting symptoms. It also focuses on the racial/ethnic variables that might affect physiological functioning and the interaction between different variables to affect the patient.
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Musculoskeletal Pathophysiological Processes
The patient has been diagnosed with osteoarthritis. Osteoarthritis is a common musculoskeletal disorder affecting different joints such as those of the hands, feet, knee, and face joints of the spine. The pathogenesis of osteoarthritis involves processes, including mechanical wear-and-tear, joint inflammation, and structural degeneration. These processes develop from joint overuse and the effects of aging. There is also the increased production of inflammatory cells such as cytokines and chemokines in the affected joints, hence, the inflammatory processes. Structural degeneration develops from the activation of matrix metalloproteinases. These changes expose the cartilage to stress, which lead to elevated release of matrix-degrading enzymes. Additional changes such as chrondrocyte proliferation, formation of bone spurs, and joint stiffness due to bone sclerosis also occur (Aboulenain & Saber, 2024). Consequently, cartilage and joint damage occur leading to symptoms such as joint pain, inflammation, difficulty moving, and crepitus.
Racial/Ethnic Variables
Racial/ethnic variables affect physiological functioning and predisposition to osteoarthritis. Research evidence shows that osteoarthritis disproportionately affects ethnic and racial minorities. This can be seen from the data that non-Hispanic Blacks have a high prevalence of osteoarthritis compared to non-Hispanic Whites. They also have a higher prevalence of severe osteoarthritis symptoms compared to non-Hispanic Whites. Studies have also revealed that African Americans have symptomatic and radiographic knee osteoarthritis compared to non-Hispanic Whites. The severity of pain, disability, and functional limitations among ethnic minority and racial groups is higher than in non-Hispanic Whites. In some studies, African American women were found to be twice at risk of disability six years from a diagnosis of osteoarthritis compared to non-Hispanic White women. Complex factors contribute to disparities in osteoarthritis in different races and ethnicities (Vaughn et al., 2019; Xu & Wu, 2021). However, researchers agree that genetics, access to healthcare services, dietary practices, and physical activity contribute to the observed differences in populations.
Process Interaction
The patient’s health status such as being diabetic and having hypertension affect osteoarthritis. Patients with diabetes mellitus have elevated risk of developing osteoarthritis. The increased risk is attributable to other risk factors such as obesity, physical inactivity, and poor dietary habits and not diabetes. The microcellular environment in patients with diabetes mellitus also accelerates inflammatory processes and joint destruction, which worsens osteoarthritis symptoms (Chowdhury et al., 2022). Hypertension is also associated with increased risk for knee osteoarthritis and severe symptoms. Most patients with hypertension have osteoarthritis as a comorbid condition (Lo et al., 2021). The association between osteoarthritis and hypertension diminishes when patients adopt healthy lifestyles and behaviors such as those contributing to weight loss.
Conclusion
In summary, different pathophysiologic mechanisms contributed to the patient’s symptoms. Racial/ethnic variables contribute to osteoarthritis predisposition. For example, African Americans have a higher prevalence of osteoarthritis compared to non-Hispanic Whites. Patient variables such as diabetes and hypertension influence symptom severity in osteoarthritis.
References
Aboulenain, S., & Saber, A. Y. (2024). Primary Osteoarthritis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK557808/
Chowdhury, T., Bellamkonda, A., Gousy, N., & Deb Roy, P. (2022). The Association Between Diabetes Mellitus and Osteoarthritis: Does Diabetes Mellitus Play a Role in the Severity of Pain in Osteoarthritis? Cureus, 14(1), e21449. https://doi.org/10.7759/cureus.21449
Lo, K., Au, M., Ni, J., & Wen, C. (2021). Association between hypertension and osteoarthritis: A systematic review and meta-analysis of observational studies. Journal of Orthopaedic Translation, 32, 12–20. https://doi.org/10.1016/j.jot.2021.05.003
Vaughn, I. A., Terry, E. L., Bartley, E. J., Schaefer, N., & Fillingim, R. B. (2019). Racial-Ethnic Differences in Osteoarthritis Pain and Disability: A Meta-Analysis. The Journal of Pain : Official Journal of the American Pain Society, 20(6), 629–644. https://doi.org/10.1016/j.jpain.2018.11.012
Xu, Y., & Wu, Q. (2021). Trends and disparities in osteoarthritis prevalence among US adults, 2005–2018. Scientific Reports, 11(1), 21845. https://doi.org/10.1038/s41598-021-01339-7
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The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
The 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.
A 74-year-old female presents to the clinic with complaints of increased difficulty in getting up from a seated position and worsening right knee pain over the last few months. The patient reports the pain is a 6/10 and is not relieved with Tylenol. The pain is sharp at times to her knees but aches at night when she is trying to rest. The patient denies any recent injuries to her knee. The patient has a history of diabetes type 2 and hypertension. The patient is taking metformin 500mg PO twice daily and lisinopril 10mg po daily. Patient is 5’8” and weighs 220 pounds. BP is 122/84, pulse is 72, resp 18, regular and non labored, pulse ox 96%, and temp 98.8F. Physical exam reduced ROM to right knee and complaints of pain with flexion; bilateral knee crepitus worse in the right knee. No erythema to knee joints but mild edema noted bilaterally. The patient reports tenderness to both knees upon palpation. Diagnostic testing ESR 14 mm/hr. CMP otherwise normal except for non fasting glucose of 220 mg/dL. Right and left knee xray: Moderate degenerative changes with joint space narrowing, no radiographic evidence of osteoporosis or joint effusion. Based on this result and exam findings the patient is given a diagnosis of osteoarthritis.