NURS 6512 Week 8 Assessment of the Musculoskeletal System
A 46-year-old man walks into a doctor’s office complaining of tripping over doorways more frequently. He does not know why. What could be the causes of this condition?
Without the ability to use the complex structure and range of movement afforded by the musculoskeletal system, many of the physical activities individuals enjoy would be curtailed. Maintaining the health of the musculoskeletal system will ensure that patients live a life of full mobility. One of the most basic steps that can be taken to preserve the health of the musculoskeletal system is to perform an assessment.
This week, you will explore how to assess the musculoskeletal system.
Learning Objectives
Students will:
- Evaluate abnormal musculoskeletal findings
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal system
- Evaluate musculoskeletal X-Ray imaging
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 4, “Vital Signs and Pain Assessment” (Previously read in Week 6)
- Chapter 22, “Musculoskeletal System”This chapter describes the process of assessing the musculoskeletal system. In addition, the authors explore the anatomy and physiology of the musculoskeletal system.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (“Muscle Strength Grading”) (Previously read in Weeks 1, 2, 3, 4, and 5)
- Chapter 3, “SOAP Notes”This section explains the procedural knowledge needed to perform musculoskeletal procedures.
Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.
This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.
Document: Episodic/Focused SOAP Note Exemplar (Word document)
Document: Episodic/Focused SOAP Note Template (Word document)
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 13, “The Spine, Pelvis, and Extremities” (pp. 585–682)In this chapter, the authors explain the physiology of the spine, pelvis, and extremities. The chapter also describes how to examine the spine, pelvis, and extremities.
Required Media (click to expand/reduce)
Musculoskeletal System – Week 8 (12m)
Online media for Seidel’s Guide to Physical Examination
In addition to this week’s resources, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 21 that relate to the assessment of the musculoskeletal system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Discussion: Assessing Musculoskeletal Pain
Photo Credit: Getty Images/Fotosearch RF
The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.
In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To prepare:
- By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
- Review the following case studies:
Case 1: Back Pain
Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?
Case 2: Ankle Pain
Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.
A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?
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Case 3: Knee Pain
Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?
With regard to the case study you were assigned:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study you were assigned.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.
By Day 3 of Week 8
Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 8
Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Submission and Grading Information
NURS 6512 Week 8 Assessment of the Musculoskeletal System Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 of Week 8 and Respond by Day 6 of Week 8
To Participate in this Discussion:
Week 8 Discussion
Assignment: Lab Assignment (Optional): Practice Assessment: Musculoskeletal Examination
A description of symptoms alone is not enough to form an accurate diagnosis of musculoskeletal conditions. Before forming a diagnosis, advanced practice nurses need to perform a physical examination. Although the musculoskeletal examination is relatively simple, it still needs to be performed multiple times before it can be mastered.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a musculoskeletal examination this week.
Note: This is a practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with your volunteer “patient” to perform a musculoskeletal examination.
- Download and review the Musculoskeletal Checklist provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.
The Lab Assignment
Complete the following in Shadow Health:
- Musculoskeletal (Practice)
What’s Coming Up in Week 9?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will examine appropriate methods for assessing the cognition and the neurologic systems during your Discussion. You also will complete the last assessment, Comprehensive (Head-to-Toe) Physical Assessment. Once again, you will conduct this assessment in the Digital Clinical Experience using the simulation tool, Shadow Health. Make sure to plan your time accordingly.
Week 9 Required Media
Photo Credit: [fergregory]/[iStock / Getty Images Plus]/Getty Images
Next week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.
A Sample Answer For the Assignment: NURS 6512 Week 8 Assessment of the Musculoskeletal System
Title: NURS 6512 Week 8 Assessment of the Musculoskeletal System
S.
CC: Low back pain for one month
HPI: The patient is a 42-year-old Caucasian man who has been experiencing lower back pain since struggling to lift a large object at work a month ago. The pain is described as “sharp and scorching” and radiates down his leg’s left side. Sleep deprivation and difficulty working are among the symptoms described by the patient. With exercise, bending over, and straining, the pain worsens. The level of discomfort is an eight on a ten-point scale. Rest and ibuprofen 600mg orally every four hours to relieve pain, which is assessed at a four out of 10 for intensity.
Location: low back
Onset: one month ago
Character: the pain is sharp and scorching and radiates down his leg’s left side.
Associated signs and symptoms: sleep deprivation
Timing: after straining, bending, or exercise
Exacerbating/ relieving factors: exacerbated with bending or straining, relieved by taking pain medication.
Severity: 4/10 pain scale
Current Medications: ibuprofen 200mg prn pain, Losartan 50mg orally daily, and rosuvastatin 20mg orally daily.
Allergies: No Known Food or Drug Allergies, allergic to latex or pollen.
PMH: The patient denies having ever had arthritis or osteoporosis in her past. The patient has a history of hypertension and hyperlipidemia that is controlled with medication, seasonal allergies, and cholecystectomy on August 17th, 2018. Pt denies having undergone any other procedures or hospitalization. Tdap (06/12/2021) and flu and pneumonia vaccines (10/07/2021) are all current on the patient’s medical record.
Soc Hx: the patient enjoys spending time with friends and playing slow-pitch softball. He also used to play baseball while in college. The patient is married with two teenage children who live in a remote region, attend church regularly, and volunteer their time. The patient denies using illicit drugs or cigarettes.
Fam Hx: Father 64 with hypertension and hyperlipidemia; mother 60 with hypothyroidism; wife 34; son 14, healthy; daughter 12, healthy; mother 60 with hypertension and hypothyroidism; father 64; mother 60; wife 34; son 14, healthy; daughter 12, healthy.
ROS:
GENERAL: fatigue, weakness, denies having fever.
HEENT: patient denies changes in vision or blurry vision and denies cough, congestion, or hearing loss.
SKIN: reports no itching or rash
CARDIOVASCULAR: no dizziness, chest pain, or edema.
RESPIRATORY: denies cough, wheezing, or sputum
GASTROINTESTINAL: No nausea, vomiting, or diarrhea
GENITOURINARY: patient denies polyuria, dysuria, frequency, or urgency.
NEUROLOGICAL: patient denies dizziness, headache, syncope, or hx of fainting
MUSCULOSKELETAL: Lower back pain that radiates down the patient’s left leg is creating aberrant gait patterns and restricted range of motion in the patient. The patient denies having ever had arthritis, gout, or a fall.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema, or rhinitis.
O.
Physical exam
V/S: V/ S: B/P 130/80, P 87, RR 19, T 98.4 F, O2 97%, Wt 202lbs, Ht 71”
GENERAL: The patient is sitting straight on the test table with a small grimace, and some grumbling can be heard. NAD, which is neatly groomed and appropriately attired, gives the impression that he is older than he appears. The patient is attentive and gives thoughtful responses.
HEENT: the mouth has no ulcers, no scars, ears are in the correct orientation.
CHEST: no chest pains, no wheezes, normal breath sounds.
MUSKULOSKELETAL: Muscle tone and strength are excellent, except for the left leg, which is weak due to pain. Pain in the lower back left hip, and a lack of mobility causes the left leg. Scoliosis is not present, and the spine is straight and symmetrical with no masses or nodules palpable and no soreness observed. The back is symmetrical.
Diagnostic results:
x-ray: To eliminate the possibility of a broken bone, a tumor, or bony protrusion, an X-ray is performed (Jenkins et al., 2018). Low Back Pain (Acute) claimed that quick x-ray use was not evidence-based practice, and AHRQ suggests waiting six weeks if pain continues to perform x-rays (Fujimoto et al., 2109).
A.
Differential Diagnoses
- Lumber sciatica- Lower back discomfort should always be considered to be caused by radiculopathy, which is caused by compression of nerve roots and results in back pain that radiates into the lower extremities (Kim et al., 2018).
- 2. Degenerative disc disease- Back discomfort radiates down the leg when fibrocartilage-based structures between the vertebrae begin to degrade or protrude against nerve roots or the spinal cord, which is what causes this problem (Battié, Joshi & Gibbons, 2019).
- Lumbar spinal stenosis- pain that begins in the lower back and buttocks and can travel down the legs can be caused by a narrowing of the spinal cord canal caused by bone or ligament hypertrophy (Lee et al., 2020).
- Spinal fracture- An injury to the vertebrae in the lower back can result in discomfort and the irritation of nerve roots, which can cause pain to radiate via the affected nerves.
- Lumbar muscle strain- present with pain in the lower back which is relieved by lying flat.
References
Battié, M. C., Joshi, A. B., & Gibbons, L. E. (2019). Degenerative disc disease. Spine, 44(21), 1523-1529. https://doi.org/10.1097/brs.0000000000003103
Fujimoto, K., Inage, K., Eguchi, Y., Orita, S., Toyoguchi, T., Yamauchi, K., Suzuki, M., Kubota, G., Sainoh, T., Sato, J., Shiga, Y., Abe, K., Kanamoto, H., Inoue, M., Kinoshita, H., Norimoto, M., Umimura, T., Koda, M., Furuya, T., … Ohtori, S. (2019). Dual-energy X-ray Absorptiometry and Bioelectrical impedance analysis are beneficial tools for measuring the trunk muscle mass of patients with low back pain. Spine Surgery and Related Research, 3(4), 335-341. https://doi.org/10.22603/ssrr.2018-0040
Jenkins, H. J., Downie, A. S., Maher, C. G., Moloney, N. A., Magnussen, J. S., & Hancock, M. J. (2018). Imaging for low back pain: Is clinical use consistent with guidelines? A systematic review and meta-analysis. The Spine Journal, 18(12), 2266-2277. https://doi.org/10.1016/j.spinee.2018.05.004
Kim, J., Van Rijn, R. M., Van Tulder, M. W., Koes, B. W., De Boer, M. R., Ginai, A. Z., Ostelo, R. W., Van der Windt, D. A., & Verhagen, A. P. (2018). Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropractic & Manual Therapies, 26(1). https://doi.org/10.1186/s12998-018-0207-x
Lee, B. H., Moon, S., Suk, K., Kim, H., Yang, J., & Lee, H. (2020). Lumbar spinal stenosis: Pathophysiology and treatment principle: A narrative review. Asian Spine Journal, 14(5), 682-693. https://doi.org/10.31616/asj.2020.0472
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Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
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Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource