NURS 6512 Discussion Musculoskeletal Pain

NURS 6512 Discussion Musculoskeletal Pain

NURS 6512 Discussion Musculoskeletal Pain

S.

CC (chief complaint): “I feel pain in my ankles, but the right one is more intense.”

HPI:

R.K is a 46-year-old A.A female presenting with a chief complaint of pain in her ankles. She reports that the pain in the right ankle is more intense.  The ankle pain began three days ago when she was playing soccer at the women’s soccer club in her church. She states that she heard a pop sound in her right ankle when playing, which was followed by a sudden intense pain on the right ankle, and she was unable to stand on the right foot. She has, however, been able to walk on the right foot, although it is uncomfortable. R.K also reports having some degree of tenderness and swelling on the right ankle. The ankle pain is aggravated by walking and relieved to some degree by OTC Tylenol, which she takes when the pain aggravates. She rates the pain on the left ankle as 3/10 and the right ankle as 6/10 on the pain scale.

Current Medications: OTC Tylenol 1 gm for pain.

Vitamin C supplements.

Allergies: Allergic to penicillin- causes rash, hives, and itchy eyes. No known food or seasonal allergies.

PMHx: Last Influenza shot-7 months ago. Last Tetanus- 3 years ago. No history of chronic illnesses. History of an appendectomy at 34 years. History of Tonsillectomy at 7 years.

Soc Hx:

R.K is a community youth counselor and has a diploma in Counseling. The patient is married. She currently lives with her spouse and three children aged 17, 14, and 8. Her hobbies include traveling and playing football. She is the captain of the women’s soccer club in her church and is the assistant coach for the junior girls’ soccer club. She reports taking wine occasionally but denies smoking tobacco or using illicit substances. She reports having a strict diet and taking about 7 glasses of water a day. The patient states that she has an active lifestyle and takes a morning run for about 40minutes at least 5 days a week. She also plays football on weekends. Her last health exam was 2 years ago.  She states that her support system is her family and sisters.

Fam Hx: Family history of HTN- mother and maternal grandfather. History of breast cancer- paternal grandmother. The elder sister has a history of Asthma. Children are alive and well.

ROS:

GENERAL: Denies elevated body temperature, reduced energy levels, chills, or weight loss/gain.

HEENT:  No history of head trauma, visual changes, hearing loss, ear discharge, nasal discharge/blockage, sneezing, or pain/difficulty swallowing.

SKIN:  Denies color changes, itching, or lesions.

CARDIOVASCULAR:  No history of swelling, chest discomfort, heart palpitations, or dyspnea at rest or exertion.

RESPIRATORY:  No history of chest pain, cough, sputum, or dyspnea.

GASTROINTESTINAL:  Denies appetite changes, nausea/ vomiting, abdominal discomfort, or diarrhea/constipation.

GENITOURINARY:  Denies abnormal PV discharge, dysuria, or urinary frequency/urgency. LMP-3 weeks ago.

NEUROLOGICAL: Negative for dizziness, headache, paralysis, or burning sensations in the extremities.

MUSCULOSKELETAL: Positive for ankle pain and swelling. Limitations in movement. Denies joint stiffness/pain/enlargement.

HEMATOLOGIC:  No history of bleeding or blood transfusion.

PSYCHIATRIC:  Denies history of mental illnesses.

ENDOCRINOLOGIC: Negative for excessive perspirations, cold/heat intolerance, excessive urination, or acute thirst.

ALLERGIES: Allergic to penicillin.

O.

Physical exam:

VITAL SIGNS: BP- 126/74; HR- 98; RR-20; Temp-98.78 F

HT-5’4; WT- 136 pounds.

GENERAL: Neat and well-groomed female in no acute distress. Alert and oriented X4. Speech is clear and goal-directed. Maintains eye contact and exhibits a positive attitude.

CARDIOVASCULAR: Negative for JVD or edema. RRR; S1and S2 audible. No gallop sounds or murmurs heard on auscultations.

RESPIRATORY: Smooth and uniform respirations. Chest clear on auscultation.

MUSCULOSKELETAL: No skin color changes at the ankles.

Left Ankle- No bruising, swelling, or loss of function. Mild tenderness at the anterior aspects of the lateral malleoli. Negative ligamentous laxity with anterior drawer and talar tilt testing.  Decreased total ankle motion of 2 degrees. No bony point tenderness. No difficulty bearing weight.

Right ankle- Bruising present. Moderate tenderness at the maximal points of the anterior (ATFL) aspect of the lateral malleoli on the right ankle. Positive anterior drawer test, negative talar tilt test- moderate joint instability. Some loss of function. Decreased total ankle motion of 7 degrees. Pain with weight-bearing and walking. No bony point tenderness.

Diagnostic results:

X-ray of the right ankle: An X-ray will be required to exclude fractures.

The Ottawa ankle rules indicate that ankle radiographs should be obtained in the event of pain in the malleolar region and any of the following: Pain on the posterior margin of the distal 6 cm or apex of the lateral malleolus; Pain on the posterior margin of the distal 6 cm or apex of the medial malleolus; and Incapacity to bear weight right away after an injury and for four steps during the assessment (Wells et al., 2019).

A.

Differential Diagnoses

Acute Lateral Ankle Sprain

An ankle sprain entails an inversion-type twist of the foot, accompanied by pain and edema. Lateral ankle sprains are the most prevalent injury in physically active populations, primarily among teenagers and young adults (Herzog et al., 2019). Clinical features of ankle sprains include pain, tenderness, swelling, bruising, muscle spasm, and cold foot or paresthesia, which suggest possible neurovascular compromise (Herzog et al., 2019). According to Wells et al. (2019), ankle sprains are categorized as Grade I, II, and III. Grade I have minimal tenderness and swelling, no loss of function, decreased total ankle motion of 5 degrees and below, and swelling of 0.5 cm or below as measured by figure-of-eight testing.

Grade II is characterized by bruising, moderate tenderness, a decreased ROM between 5-10 degrees, moderate swelling of 0.5-2.0cm, and ankle instability (Wells et al., 2019).  Grade III presents with bruising, significant swelling of greater than 2.0 cm, near-total loss of function, ankle instability, extreme point tenderness, and decreased ankle ROM > 10 degrees.

Acute Lateral Ankle Sprain is the presumptive diagnosis based on the positive findings in the right ankle, including bruises, some loss of function tenderness at the anterior aspect of the lateral malleoli, moderate joint instability, reduced ROM of 7 degrees, and pain with weight-bearing and walking. The right ankle symptoms are consistent with a grade II lateral ankle sprain.

Acute Achilles tendon ruptures

Individuals with an Achilles tendon rupture often present with a primary symptom of a sudden snap in the lower calf accompanied by acute, severe pain. According to Egger and Berkowitz (2017), Achilles tendon rupture commonly occurs in healthy, active, young- to middle-aged persons, mostly from 37 to 43.5 years old. Patients often report experiencing a popping or giving way feeling in their posterior heel after pushing off (Egger & Berkowitz, 2017). Immediate pain occurs but slowly resolves, leaving a person with difficulty with plantar flexion, weight-bearing, or limping. Besides, the person cannot stand their toes on the affected side (Egger & Berkowitz, 2017). Achilles tendon rupture is a differential diagnosis based on findings of ankle pain, popping sensation that occurred during the ankle injury, and difficulties with bearing weight.

Right Ankle Fracture

While lateral ankle sprains comprise 90% of all ankle injuries, whereas an ankle fracture occurs only in 15% of the injuries, ankle fractures occur due to a twisting mechanism sustained from a low-energy injury (Lawson et al., 2018). A fractured ankle presents with severe pain, swelling, ecchymosis, and soft tissue injuries, such as abrasions and lacerations. Other features include loss of function, limited range of motion, compromised neurovascular status, and positive talar tilt and drawer testing (Lawson et al., 2018). A Right Ankle fracture is a differential diagnosis based on pertinent positives of pain, bruising, loss of function, reduced ROM, and positive talar tilt and drawer testing indicating joint instability.

 References

Egger, A. C., & Berkowitz, M. J. (2017). Achilles tendon injuries. Current reviews in musculoskeletal medicine, 10(1), 72–80. https://doi.org/10.1007/s12178-017-9386-7

Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of athletic training, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17

Lawson, K. A., Ayala, A. E., Morin, M. L., Latt, L. D., & Wild, J. R. (2018). Ankle fracture-dislocations: a review. Foot & Ankle Orthopaedics, 3(3), 2473011418765122. https://doi.org/10.1177/2473011418765122

Wells, B., Allen, C., Deyle, G., & Croy, T. (2019). MANAGEMENT OF ACUTE GRADE II LATERAL ANKLE SPRAINS WITH AN EMPHASIS ON LIGAMENT PROTECTION: A DESCRIPTIVE CASE SERIES. International journal of sports physical therapy, 14(3), 445–458. https://doi.org/10.26603/ijspt20190445

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?

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

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

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Name: NURS_6512_Week_8_Discussion_Rubric
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Excellent Good Fair Poor
Main Posting Points Range: 45 (45%) – 50 (50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 40 (40%) – 44 (44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 35 (35%) – 39 (39%)
“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Points Range: 0 (0%) – 34 (34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness Points Range: 10 (10%) – 10 (10%)
Posts main post by Day 3. Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response Points Range: 17 (17%) – 18 (18%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Points Range: 13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 12 (12%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response Points Range: 16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 14 (14%) – 15 (15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Points Range: 12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 11 (11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days. Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.

Subjective

CC: Lower back pain

HPI: Hispanic male patient JM, age 42, presented to the clinic today complaining of severe lower back pain over the past month. Periodically, the pain travels along his left leg. He felt a sharp, throbbing pain in his left lower leg, along with a tingling feeling. He said the ache in his back was an eight out of ten. He feels more discomfort when he lifts heavy objects, bends, or sits for lengthy periods of time. He says over-the-counter ibuprofen helps a little.

Current Medications:

OTC Ibuprofen 400mg Q4hrs as needed for pain.

Claritin 10mg daily for allergies

Lisinopril 5mg daily for hypertension

Allergies: No known drug allergy; environmental allergies: Pollen (Reaction- sneezing and watery eyes).

PMHx: Medical history includes hypertension 5 years ago. No hospitalizations. His vaccinations are all current.

Past surgical Hx: No surgical history reported.

Social Hx: JM has a high school diploma and is employed as a bricklayer for a local construction company. He is married and resides in a three-bedroom home with his wife and 10-year-old son. For the last ten years, he has been smoking one pack of cigarettes per day. He denied consuming alcohol or using illegal substances. Because of his back pain, he refuses to exercise on a regular basis. He follows a healthy diet that includes fruits and vegetables.

Family Hx: Mother is 65 years old, living, and has been diagnosed with high blood pressure and high cholesterol. His father is 70 years old, living and suffering from hypertension and benign prostatic hyperplasia. Grandpa on the mother’s side passed away at age 64 due to heart attack complications. Maternal grandmother died at age 73 from asthma and diabetes related problems. His paternal grandfather passed away at age 71 due to COPD-related illnesses. His paternal grandmother was 55 years old when she passed away from lung cancer. At the age of 45, one sibling was diagnosed with multiple sclerosis. One healthy kid of 10 years old.

ROS:

General: Reported intermittent tingling and numbness in the left limb. No reports of fever, chills, or weight loss.

HEENT: Denies head injury, blurred vision, hearing loss. No changes in smell or taste reported. No complaints of epistaxis.  No sore throat was reported.

Skin: No skin lesion, mole, or rash.

Cardiovascular: No reports of heart murmur, chest discomfort, and irregular heartbeat.  No edema in the extremities.

Respiratory: No reports of cough or dyspnea.

Neurological: Denies migraines, fainting, or convulsions. No reports of coordination problems.

Musculoskeletal: Pain in the lower back and sometimes in the left leg. Denies that other parts of the body have swollen joints or muscle pain.

Hematologic/Lymphatic: Denies bleeding or bruising. Denies enlarged nodes or history of splenectomy.

Endocrine: No heat or cold intolerance reported. No c/o polydipsia or polyuria.

 Objective

Physical Exam:

General: Patient is alert and oriented x3. He is calm and answers interview questions appropriately. He is well-nourished and well- developed. He reports weakness to the left lower extremity.

Vitals: BP- 145/88mmHg; HR- 90bpm and regular; Resp- 19bpm and regular; Temp- 98.5F orally; SPO2 99%R/A; Height- 5’8”; Weight- 166lbs; BMI- 25.2.

Skin: Turgor is good. No rashes or lesions.

HEENT: Head is normocephalic. PERRLA. Conjunctivae negative for exudate and hemorrhage. External auditory canal is patent. Ears are nontender and not swollen. Nares are patent. Nasal mucosa is pink without drainage. Oral mucosa is moist, pink with no lesions. No tonsillar swelling, no pharyngeal swelling.

Cardiovascular/peripheral Vascular: Presence of S1S2 heart sounds during auscultation; no murmurs. Heart rate regular rhythm. Peripheral pulses 2+ symmetrical bilaterally. No peripheral edema.

Respiratory: Chest symmetrical. No adventitious lung sound auscultated.

Gastrointestinal: Abdomen is symmetrical. Normoactive bowel sounds x four quadrants. Abdomen is soft, nontender. No palpable masses.

Musculoskeletal: Low back pain with flexion, extension, and twisting. Limited ROM to lower extremities. No sign of trauma to lower back.

Neurological: Alert and oriented x3. Appropriate affect and mood.

Diagnostic Test:

1. Complete blood count (CBC) to verify infection (high WBC count).
2. Erythrocyte sedimentation rate (ESR) to detect inflammation.
3. A computed tomography (CT) scan to detect unusual tissues and analyze the patient’s spinal status.
4. Imaging of the spinal cord and nerves using (MRI) magnetic resonance imaging (Dains et al., 2019).

 Assessment

Differential Diagnosis:

5. Lumber disc herniation (LDH): Lumbar disc herniation is defined as the movement of disc material (annulus fibrosis or nucleus pulposus) over the intervertebral disc area, causing low back and/or leg pain (Yang et al., 2022). It usually starts with lower back discomfort that spreads down one leg and is often followed by sensations of numbness or tingling in the lower leg. The symptoms of LDH correspond to the patient’s chief concern.
6. Sciatica: Sciatica is characterized by radiating and tingling pain down the leg and lower back caused by inflammation or compression of the lumbosacral nerve roots (Jensen et al., 2019). Furthermore, sciatica is frequently brought on by a herniated spinal disk, excessive movement, or heavy lifting, according to Dains et al. (2019). The patient is overweight, and his job requires heavy lifting and recurrent movements, which may contribute to his lower back pain.
7. Lumber Spinal Stenosis (LSS): Lumbar spinal stenosis (LSS) is a degenerative disc condition that causes the area encompassing the vertebrae’s neurovascular systems to narrow (Fishchenko et al., 2018). Symptoms of nerve inflammation or compression include discomfort and weakness or numbness in the legs. A history, physical examination, and imaging studies are used to make the diagnosis. The assessment should concentrate on leg or buttock pain while ambulating and stretching to alleviate symptoms (Chagnas et al., 2019).
8. Piriformis Syndrome (PS): Muscle spasm in the piriformis and/or irritation of the sciatic nerve in the area are the root causes of piriformis syndrome, as stated by Siddiq & Rasker (2019). Physical examination, patient history, and imaging studies like x-rays are used to determine the diagnosis of PS. The authors indicated that the flexion-adduction-internal rotation test, the Pace sign, and the Freiberg techniques are used to identify individuals with PS. Pain and weakness by resisted abduction and external rotation of the hip while seated suggests signs of Pace. The Freiberg sign manifests as pain and weakness with passive forced internal rotation of the hip in a supine position.
9. Lumbar spondylolisthesis: Low back pain, lower limb radiating pain, and sporadic neurogenic claudication are symptoms of lumbar spondylolisthesis, a degenerative condition of the lumbar spine (Wang et al., 2022). The patient’s symptoms match the above statement, too.

                                                                                     References

Chagnas, M.-O., Poiraudeau, S., Lef vre-Colau, M.-M., Rannou, F., & Nguyen, C. (2019).

Diagnosis and management of lumbar spinal stenosis in primary care in france: A survey

of general practitioners. BMC Musculoskeletal Disorders, 20(1).

https://doi.org/10.1186/s12891-019-2782-y

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.

Fishchenko, I. V., Kravchuk, L. D., & Perepechay, O. A. (2018). Lumbar spinal stenosis: symptoms, diagnosis and treatment (meta-

analysis of literature data). Pain Medicine, 3(1), 18–32. https:// doi -org.ezp.waldenulibrary.org/10.31636/pmjua.v3i1.83

Jensen, R.K., Kongstead, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ. 16273.

https://doi.org/10.1136/bmj.16273

Siddiq, M. B., & Rasker, J.J (2019). Piriformis pyomyositis, a cause of piriformis syndrome-a systematic search and review. Clinical

            Rheumatology, 38(7), 1811-1821. https://doi.org/10.1007/s10067-019-04552-y

Wang, P., Zhang, J., Liu, T., Yang, J., & Hao, D. (2022). Comparison of degenerative lumbar

spondylolisthesis and isthmic lumbar spondylolisthesis: Effect of pedicle screw

placement on proximal facet invasion in surgical treatment. BMC Musculoskeletal

            Disorders, 23(1). https://doi.org/10.1186/s12891-021-04962-7

Yang, S., Shao, Y., Yan, Q., Wu, C., Yang, H., & Zou, J. (2021). Differential diagnosis strategy

between lower extremity arterial occlusive disease and lumbar disc herniation. BioMed

            Research International, 2021, 1–5. https://doi.org/10.1155/2021/6653579

Total Points: 100
Name: NURS_6512_Week_8_Discussion_Rubric