1. 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.

2. 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?
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.

3. 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.
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)

4. 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.
Chapter 22, “Lower Extremity Limb Pain”
This chapter outlines how to take a focused history and perform
a physical exam to determine the cause of limb pain. It includes
a discussion of the most common tests used to assess
musculoskeletal disorders.
Chapter 24, “Low Back Pain (Acute)”
The focus of this chapter is the identification of the causes of
lower back pain. It includes suggested physical exams and
potential diagnoses.
Sullivan, D. D. (2019).
Guide to clinical documentation
(3rd ed.). Philadelphia, PA: F. A. Davis.

5. 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.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. (2019). Musculoskeletal system: Student
checklist. In
Seidel's guide to physical examination: An interprofessional
approach
(9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. (2019). Musculoskeletal system: Key points. In
Seidel's guide to physical examination: An interprofessional
approach
(9th ed.). St. Louis, MO: Elsevier Mosby.

6. Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P.,
Holt, H. L., … Losina, E. (2011). Medical decision-making
among Hispanics and non-Hispanic Whites with chronic back
and knee pain: A qualitative study.
BMC Musculoskeletal Disorders, 12
(1), 78–85.
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.
Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., &
Tomkins-Lane, C. C. (2014). Does physical activity influence
the relationship between low back pain and obesity?
The Spine Journal, 14
(2), 209–216. doi:10.1016/j.spinee.2013.11.010
Shiri, R., Solovieva, S., Husgafvel-Pursiainen, K., Telama, R.,
Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E.
(2013). The role of obesity and physical activity in non-specific
and radiating low back pain: The Young Finns study.
Seminars in Arthritis & Rheumatism, 42
(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002
Document
: Episodic/Focused SOAP Note Exemplar (Word document)

7. 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)
Accessible player --Downloads--Download Video
w/CCDownload AudioDownload Transcript
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

8. . 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/
USE 5 RESOURCES FROM SCHOOL