Discussion: Assessing Musculoskeletal Pains
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.
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
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
Consider what history would be necessary to collect from the patien 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
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
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
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
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
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
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
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.
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
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: Key points. 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.
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.
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.
Document: Episodic/Focused SOAP Note Exemplar (Word document)
Document: Episodic/Focused SOAP Note Template (Word document)
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,
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/
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