Polyarthritis Case Studies

S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94%

SKIN: She has some mild ecchymosis on her skin, and some erythema. She has patches but no obvious skin breakdown. She has some fissuring in the buttocks crease. PULMONARY: Clear to percussion and auscultation bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, nontender, protuberant, no orgonomegaly, and positive bowel sounds. NEUROLOGIC EXAM: Cranial nerves II through XII are grossly intact. Diffuse hyporeflexia. MUSCULOSKELETAL: Erosive, destructive changes in the elbows, wrists, and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stovepipe legs, and perimalleolar pitting edema 1 +. I feel no pulses distally in either leg. PSYCHIATRIC: Patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services. She refused for now.

Shirley Caretaker is a 56 year-old widow who spent the last twenty-five (25) years working in the health care field as a Certified Nurse’s Assistant and Licensed Practical Nurse. Ms. Caretaker’s job-related knee pain was worsened by a work related accident, which also injured her hip and back. She cannot sit or stand for more than 30 minutes at a time, or walk for more than 10 minutes. Pain in her upper back radiates up her neck and through her fingers, which causes her arms and fingers to periodically feel

The patient is 67-year-old gentleman who was discharged from a nursing home 2 days ago after 3 months stay. The patient had a right ruptured quadriceps tendon which was repaired in a Morris Town hospital and he was in the Atrium of Wayne for rehabilitation and discharged home. Since being discharged home he has presented himself three separate times to the emergency room, the final one being on 6/10 here at St. Joseph's where he was admitted. He presented the previous day and he was discharged. The patient presented because his right leg was collapsing while using a walker. CT done in the ED of his right knee shows that he has severe tricompartmental arthritis and loose bones. The patient is in severe pain and he is unable to ambulate. The patient lives alone in his own home. The decision was made that the safest thing was for him to be admitted acutely inpatient to try to sort through the issues that have led up to this point. No arrangements have been made for him to have any outpatient therapy. or any from the Atrium at Wayne. His medical history is significant for having previous cardiac caths. He developed MRSA infection after a quadriceps rupture in Morristown. He has allergic reactions to Metformin (not quite sure what the reaction is). As previously stated he lives alone in a home in Totowa. Physical therapy evaluation reveals the patient is not safe ambulating with a walker and obviously needs intervention. He will need some type of assistive help in the home or long-term care. After much discussion the Atrium agreed to take the patient back while we work through the issues of how he could be cared for in a

At today's visit she is home alone. She is awake and alert. She complains of burning, Shooting pain in right Buttocks and hip area that radiates down her leg. Severity 10 out of 10, she currently takes OxyContin 40 mg every 12 hours and Percocet 10/325 every four hours as needed. She states that her pain is very debilitating and prevents her from leaving the house. She ambulate's short distances with a walker but has to take frequent rest periods.She states that this pain regimen is not helping much. She was going to resolute for outpatient pain management but at the moment she's unable to get out to her appointments due to her sciatica pain. She complains of chronic constipation.

James Phillips, a 16 year old, Caucasian male presented to the emergency department with joint pain, loss of appetite, and fatigue. Accompanied by his mother, she said his fever was on and off for the last 1 months and had episode of high grade fever for 3 days in a week. She further explained he has experienced several nose bleeds in the last 3 weeks. Vital signs were taken and Temperature was 100.4˚F, his pulse rate was107 bpm, and blood pressure was 136/68 mmHg. Patient is 5'10" weighing 150 pounds. Mother said patient has lost 10 pounds in 1 month but his routine has not changed. During assessment, pallor was noted, palpable nodules noted in bilateral axillary region, and multiple bruises noted on left and right lower extremities. Patient

Resident has significant loss of function of the left shoulder and right knee. Rest of the joints and muscle groups are within the functional limits. Right knee fixed flexion deformity (approximately 35 degrees), left shoulder AROM limited to 20 degrees in all direction. Resident has good sitting balance. Able to stand up at the rail/with 4WW with two assists at the rail. His standing balance is very poor. Resident is at

Polyarteritis Nodosa is an autoimmune disease caused by immune deposition in the wall of small to medium sized muscular arteries.13 This process promotes infiltration with polymorphic leukocytes and liberation of necrotizing enzymes, leading to thrombosis, tissue ischemia, fibrosis, and ultimately tissue scarring. PAN may affect virtually every organ system and has a wide constellation of clinical manifestations (Table 1).14 Establishing the diagnosis of PAN is very difficult as there are no laboratory abnormalities specific for PAN. Acute phase reactants, such as erythrocyte sedimentation rate and C-reactive protein, are commonly increased.14 Chronic anemia is also frequently present.14 Histopathological evidence of vascular inflammation

At today's visit, she is found sitting in her chair. She is awake, alert. She complains of chronic dull, intermittent pain in her right lower extremity with a severity of 4/10. She states that her current pain regimen helps relieve her pain. The staff reports that she her pain regimen seems to manage her pain well. She denies shortness of breath, depression and chest pain.

S The patient is a 54-year-old female who sustained an injury on 04/25/2012. She complained of ongoing pain in the low back and neck.

Synovitis is inflammation of the synovium joint lining within the knee. Most symptoms are short lived and tend to move to different places of overuse, joined by severe pain. Lack of swelling and tenderness could also be a significant sign for synovitis, partially due to the injury being caused by overuse. Diagnosis is determined by a rheumatologist who deciphers the difference of pain by location. Recovery is generally based on rest and anti-inflammatory medications (HSS,

25-year-old female pt of Asian (Pakistani) ethnicity reported to outpatient rehabilitation. After initial success with physical therapy in 2015, pt reports to physical therapy once again with low back pain. As a result of the MRI, patient was diagnosed with Spondylolisthesis at L5-S1 secondary to loss of disc height and mild degenerative spondylosis at T12-L1, L1-L2 and L4-L5. Pt reports with bilateral numbness and tingling down to buttocks. Pt reports 7/10 pain in lower back around L5. Pt is anemic and has high cholesterol levels as shown in blood tests that were completed in September 2017. Pt did not undergo any surgery for spondylolisthesis and wants to avoid surgery

To perform this test, the patient should be seated or standing, while making a fist on the involved side.1 The therapist should use one hand to stabilize along the distal humerus while simultaneously palpating the medial epicondyle.1 With the other hand, the therapist should then passively supinate the forearm and extend the elbow and wrist.1 Pain or discomfort along the medial region of the elbow is positive for medial epicondylitis.1 If the patient does not experience any pain or discomfort along the medial epicondyle during this test, then they most likely do not have medial epicondylitis.1

She has a lot of difficulty kneeling or squatting or climbing one flight of stairs. She can only walk short distances. The patient is able to continue performing regular work.

A review of her medical records indicates that she went to the ER on 12/4/16 with complaints of back pain as a result of her fall she had 2 days prior. She was prescribed Norco 5/325 mg p.o every 4 hours prn. She has an extensive history of falling at home due to her Parkinson disease which is progressive. She suffers from Parkinson with resulting tremors. She is receiving physical therapy from signature home health. She suffers from co-morbidities of chronic HTN, which is managed with medication, CAD which is stable, Chronic hypotension which is managed with medication, depression which is stable.