“A 64-year-old male presents to the clinic with complaints of gradual onset of weakness to the left hand. He is left hand dominant. He has had ongoing numbness and tingling that feels as though it starts at his elbow. However, over the past 2-3 days he had been dropping items due to the weakness. He denies any recent injuries but state that he sustained a crushing injury to the left thumb 4 years ago. He is employed as a mechanic. Several years ago, he tripped over a tire and fell backwards striking his head on the fender of a car. He didn’t seek medical attention because he only had a small scrape on his elbow. A CT of the head is within normal limits and all labs are normal with the exception of a slightly elevated, non-fasting blood sugar (135). He has no history of diabetes. An x-ray of the neck reveals mild-to-moderate degenerative disc disease at C6-C7 with neuroforaminal narrowing and slight impingement of the exiting nerve root.”
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.
Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.
An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- Both the neurological and 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.
Case Study Analysis:
The 64-year-old male patient in this case presents with complaints of gradual onset of weakness in his left hand, along with ongoing numbness and tingling that starts at his elbow. He has a history of a crushing injury to the left thumb four years ago and a fall that resulted in hitting his head on a car fender. The patient is left-hand dominant and works as a mechanic. CT scan of the head and lab results are mostly normal, except for a slightly elevated blood sugar level. An x-ray of the neck reveals degenerative disc disease at C6-C7 with neuroforaminal narrowing and impingement of the exiting nerve root.
Neurological and Musculoskeletal Pathophysiologic Processes: The patient’s symptoms can be explained by a combination of neurological and musculoskeletal pathophysiologic processes:
- Neurological: The numbness and tingling starting at the elbow suggest possible nerve involvement. The history of the fall and the presence of degenerative disc disease at C6-C7 with neuroforaminal narrowing indicate nerve compression or irritation, leading to radiculopathy. Radiculopathy is a condition where the nerve roots that exit the spinal cord become compressed or inflamed, resulting in symptoms such as weakness, numbness, and tingling in the corresponding limb (in this case, the left hand). The injury to the left thumb and the repetitive nature of the patient’s work as a mechanic may have contributed to the development of nerve compression over time.
- Musculoskeletal: The mild-to-moderate degenerative disc disease at C6-C7 and the narrowing of the neuroforamen suggest structural changes in the spine. Degenerative disc disease is a condition where the intervertebral discs in the spine break down, leading to reduced disc height and possible nerve impingement. The compression of nerve roots due to neuroforaminal narrowing and degenerative changes in the cervical spine can cause weakness and sensory disturbances in the corresponding limb, affecting the left hand function in this patient.
Racial/Ethnic Variables Impact on Physiological Functioning: While the case study does not explicitly mention specific racial or ethnic background, it is essential to recognize that these factors can impact physiological functioning. Certain racial or ethnic groups may have a higher predisposition to certain conditions or respond differently to treatments. For instance, certain populations may be more prone to developing degenerative disc disease or have varying pain thresholds. Therefore, it is crucial for healthcare providers to consider potential variations in disease prevalence, symptom expression, and treatment response based on the patient’s racial and ethnic background.
Interaction of Neurological and Musculoskeletal Processes: The neurological and musculoskeletal processes interact to affect the patient’s presenting symptoms. The degenerative changes in the cervical spine (musculoskeletal) lead to neuroforaminal narrowing and impingement of the exiting nerve root. This compression of the nerve root (neurological) results in radiculopathy, causing weakness, numbness, and tingling in the left hand. The previous crushing injury to the left thumb and the repetitive activities as a mechanic may have contributed to the vulnerability of the cervical spine and increased the likelihood of nerve compression.
In conclusion, the patient’s symptoms of weakness, numbness, and tingling in the left hand can be attributed to a combination of neurological and musculoskeletal pathophysiologic processes. The degenerative changes in the cervical spine, along with nerve root compression, play a significant role in the presentation of symptoms. Healthcare providers should consider potential racial/ethnic variables that may impact physiological functioning and tailor treatment approaches accordingly. A comprehensive understanding of these interactions is essential for accurate diagnosis and effective management of the patient’s condition.