Musculoskeletal Function

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G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.
Case Study Questions

Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.
Case Study Questions

Name the most common risks factors for Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.

Sample Solution

Case 1: G.J. – Knee Pain and Osteoarthritis

Osteoarthritis vs. Osteoarthrosis:

These terms are often used interchangeably. Osteoarthritis (OA) is the preferred term and refers to the degenerative joint disease characterized by cartilage breakdown and inflammation. Osteoarthrosis is a less commonly used term that specifically refers to the degenerative changes in the joint itself, without necessarily emphasizing inflammation.

Risk Factors for Osteoarthritis in G.J.’s Case:

  • Age:Osteoarthritis is more common with age.
  • Weight:J.’s recent weight gain of 20 pounds puts additional stress on her knees.
  • Previous Injury:The case doesn’t mention prior injuries, but they can contribute to OA.
  • Family History:Not a direct risk factor for OA, but G.J.’s concern about osteoporosis might be related to a family history of bone weakness.

Osteoarthritis vs. Rheumatoid Arthritis:

Feature Osteoarthritis (OA) Rheumatoid Arthritis (RA)
Cause Wear and tear of the joint Autoimmune disease attacking the synovial membrane (joint lining)
Symptoms Joint pain, stiffness, decreased range of motion Joint pain, stiffness, swelling, warmth, fatigue
Joints Affected Often weight-bearing joints (knees, hips, spine) Any joint, often symmetrical (both knees, hands)
Diagnosis X-ray, physical examination Blood tests, X-ray, physical examination

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Treatment Options for G.J.:

  • Non-pharmacological:
    • Weight loss: Reducing stress on the joints can significantly improve symptoms.
    • Exercise: Low-impact exercises like swimming or walking strengthen muscles and improve flexibility.
    • Physical therapy: Techniques like heat therapy and massage can alleviate pain and stiffness.
    • Joint support devices: Braces or canes can provide stability and reduce pain.
  • Pharmacological:
    • Topical pain relievers: Gels or creams applied directly to the knee can provide localized relief.
    • Acetaminophen: Can help manage pain with fewer side effects than NSAIDs for G.J.

Osteoporosis Concerns:

  • While G.J. is worried about osteoporosis, the case doesn’t mention symptoms like bone fractures, which are more indicative of the disease.
  • A bone density scan can definitively diagnose osteoporosis.
  • If diagnosed, medications and lifestyle modifications can help prevent fractures.

Case 2: H.M. – Memory Problems

Risk Factors for Alzheimer’s Disease:

  • Age:M.’s age (67) is a significant risk factor.
  • Family History:Alzheimer’s risk increases if a close relative has the disease.

Dementia Types:

  • Alzheimer’s Disease:Most common form, characterized by progressive memory loss and cognitive decline.
  • Vascular Dementia:Caused by problems with blood flow to the brain, leading to memory loss and thinking difficulties.
  • Dementia with Lewy Bodies:Abnormal protein deposits in the brain cause memory loss, movement problems, and hallucinations.
  • Frontotemporal Dementia:Affects the frontal and temporal lobes, leading to personality changes, language difficulties, and behavioral problems.

Similarities and Differences:

All types of dementia cause progressive cognitive decline, but the specific symptoms and affected areas of the brain can differ. Alzheimer’s primarily affects memory, while vascular dementia may cause more problems with attention and executive function.

Explicit vs. Implicit Memory:

  • Explicit Memory:Conscious recall of information and experiences (e.g., remembering your birthday).
  • Implicit Memory:Unconscious memories that influence behavior (e.g., riding a bike without thinking about the steps).

Diagnosis of Alzheimer’s Disease:

The National Institute on Aging and Alzheimer’s Association recommend a combination of:

  • Clinical Evaluation:A doctor assesses mental status, medical history, and family history.
  • Cognitive Testing:Standardized tests measure memory, thinking, and language skills.
  • Brain Imaging:Scans may help rule out other causes of dementia.

Treatment for H.M.:

There is no cure for Alzheimer’s, but medications can help manage symptoms and slow progression.

Additional Considerations:

 

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