Health assessment wk 8 reply

Please write a 300 word reply to my classmate, her discussion post is below. APA format. NO AI. My professor is a stickler for AI. PLEASE NO AI. scholarly written, APA formatted and a minimum of 3 references (which may include the course textbook). 

"Jamie: For this week we are to discuss acute and chronic musculoskeletal conditions.  I wanted to choose two that have specific value to me.  For the acute condition, I chose shoulder dislocations as this is something we see quite often in my current job.  For the chronic condition, I chose something that I wanted to research more about as it is something that afflicts a few of my in-laws.

Acute Musculoskeletal Condition: Shoulder Dislocation

Shoulder dislocation happens when the humeral head is not sitting in the glenoid fossa.  Most shoulder dislocations are anterior and are a result from trauma (Ball et al., 2023). When the shoulder is reduced promptly, it helps to prevent the possibility of neurovascular injury and recurrent instability (Liechti et al., 2022).

Common symptoms include the patient reporting sudden severe shoulder pain, the feeling that it “popped out”, inability to move affected arm, and in more severe cases it can cause numbness along with weakness which is indicative of nerve involvement (Ball et al., Liechti et al., 2022).  Previous history of instability and/or dislocation are the two biggest indicators of current dislocation (Ball et al., 2023).

As previously discussed, trauma is the most common cause of shoulder dislocation but there are different types of trauma; Fall On Outstretched Hand (FOOSH), trauma from direct hit to involved shoulder, and wrestlers often have this type of injury because forceful over abduction, extension and rotation can cause dislocation of the shoulder joint (Ball et a l., Liechti et al., 2022).

Upon assessment, objective findings include the inability to note the normal rounded shoulder appearance and that the patient holds the affected arm slightly abducted and externally rotated (Ball et al., 2023).  Sometimes, the humeral head is palpable anteriorly, but there is always markedly reduced range of motion to the affected side/extremity. Also, if there is neurovascular involvement, there can be a decreased capillary refill in the affected extremity as well as decreased distal pulses (Liechti et al., 2022). 

The diagnostic studies that are most commonly used are a shoulder or scapular AP view x-ray, but a CT scan can be used for more complex cases, or an MRI can be ordered post reduction especially if the dislocation is related to underlying medical conditions or concurrent soft tissue disorders such as Bankart lesions, Hill-Sachs lesions, or rotator cuff tears (Pagana et al., 2022). There is not one test that is pathognomonic for shoulder dislocation but visualization of the displacement of the humeral head via imaging is a clear indication of shoulder dislocation which could be a pathognomonic finding.

Chronic Musculoskeletal Condition: Rheumatoid Arthritis

Rheumatoid arthritis (RA) is studied during the musculoskeletal system despite it being an autoimmune disorder due to its destruction of the musculoskeletal system.  It is a chronic systemic disease without mechanism of injury that causes synovial inflammation resulting in progressive joint destruction, deformity, and ultimately disability if left untreated (Ball et al., 2023; Taylor, 2020). The patient often presents describing morning stiffness in their hands and/or wrists bilaterally that lasts longer than one hour with associated pain.  They also present with fatigue, generalized weakness, and later stages with difficulty performing ADLs (Ball et al., 2023; Taylor, 2020).  Upon assessment, there can be joint swelling, tenderness, decreased ROM, reduced grip strength, and in later disease Rheumatoid nodules, Swan-neck and boutonnière deformities are found due to the destruction of the joints.

While there is not one pathognomonic test for RA, radiology results show joint space narrowing, periarticular osteopenia, and erosions combined with a positive anti-CCP lab value, which are highly specific when combined and support the diagnosis of RA (Ball et al., 2023; Pagana et al., 2022; Taylor, 2020). There are other diagnostic studies that are useful in diagnosing the disease as well and include a positive RF, elevated ESR, and elevated CRP, but these aren’t as specific as anti-CCP serum positivity (Pagana et al., 2022; Taylor, 2020). Also, if the plain film x-rays are not indicative of RA, but there is strong suspicion, an MRI can be used to detect early synovitis and erosive changes (Ball et al., 20223; Pagana et al., 2022).

References

Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2023). Seidel’s guide to
physical examination (10th ed). Elsevier.

Liechti, D. J., Shepet, K. H., Glener, J. E., Neumann, E. J., & Sraj, S. (2022). A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century. Orthopaedic journal of sports medicine, 10(9), 23259671221121633. https://doi.org/10.1177/23259671221121633

Pagana, K.D., Pagana, T.J., & Pagana, T.N. (2022). Mosby’s manual of diagnostic and
laboratory tests (7th ed.). Elsevier.

Taylor P. C. (2020). Update on the diagnosis and management of early rheumatoid arthritis. Clinical medicine (London, England), 20(6), 561–564. https://doi.org/10.7861/clinmed.2020-0727"