Skeletal Disorders Case Report

Mr.’s Jones suffers from the following symptoms, painful joints particularly her knee, and hip, fingers and back, joint stiffness, limited joint movement and swollen feet and enlarged joints. These symptoms are due to significant problems with Rheumatoid Arthritis (RA) and Osteoarthritis (OA).

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

Per progress report dated 03/04/16, the patient complains of pain of pain in the neck and lower back. Current medication is for Norco and Gabapentin.

There is pain with lumbar flexion and extension. There is no aberrant behavior. The patient feels that he can perform increased activities of daily living with his current medications.

A 79-year-old female present with her daughter for ongoing fatigue also noted to have lost 5 pounds over past 6 months. No night sweats or fevers. Pertinent past medical history includes severe, generalized osteoarthritis, hypertension, type 2 diabetes mellitus and depression. She is taking the following medications: acetaminophen 650mg every eight hours, Lyrica 75 mg twice daily; alendronate 70 mg once weekly, valsartan 320 mg once daily, fluoxetine 40mg once daily and insulin glargine 20 units once daily. Your exam reveals slight pale conjunctivae, a 2/6 systolic ejection murmur and generalized arthritic joints in her extremities. A point of care test results in a hemoglobin of 10.2 g/dL. Complete blood cell count is done; results

He reports no major changes in his condition, since his last visit. His pain is rated as 3-6/10, described as dull, hard, aching or worse. Pain is increased with sitting, standing, walking, lifting, looking up and down, turning to the sides, bending, and twisting. He is unable to work. He is very limited physically. He has to modify or avoid social and recreational activities to manage the pain. He feels like his quality of life is severely affected. His pain is 80% in the neck and 20% in the upper extremities, mostly on the

Musculoskeletal System: Patient denies having history of arthritis or gout. She also denies the presence of pain, stiffness, swelling, deformity, limitation of motion,

At today’s visit she is seen at Tiffany hall SNF. She is found in her room. She is awake and alert and oriented. She c/o of pain in her hips and knees, that she describe as achy with a severity of 5/10, the pain does not radiate but does affect her ability to ambulate, she is using a wheelchair. Her pain regimen is Lortab 7.5 mg p.o every 4 hours. She reports that she has increased hip pain when she sleeps on her mattress because she sinks in her mattress. She is schedule to follow up with her orthopedic doctor Dr. Shute.

Per the AME report dated 07/08/15, the patient was deemed P & S with regard to her right knee and lumbar spine as of this date. Future medical care includes ongoing exercise program, occasional orthopedic visits, brief periods of PT, anti-inflammatory medications for flares, prescription medications and periodic injections.

Stand and gait is normal, pain in dermatome L5 and S1 both side , local pain in the lower lumbar area , sensation intact ,no muscle weakness , reflex status normal .

Based on the progress report dated 02/09/16, the patient presents for follow-up. He describes ongoing difficulty with pain in both shoulders, wrists, low back and the bilateral lower extremities from the knees to the calves. His symptoms include pain, spasms, numbness and tingling. He rates his pain level as a 9/10 in intensity, but it is reduced to a 7/10 with use of his medications. He reports that morphine is helping, but he is still taking 5-6 Norco a day. He is also taking a stool softener three times a day as well as Linzess. However, he continues to have significant constipation.

The patient was admitted of January 21, 2018 for physical and occupational therapy. M.G suffers from traumatic arthritis of the right hip,

The patient is an 87-year-old female who was recently hospitalized here at St. Joseph's Medical Center and discharge to rehabilitation spent approximately 3 weeks in the rehabs setting and was home for a day before she represented to the emergency room complaining of inability to move, profound weakness, right hip pain and right thigh swelling, as well as bilateral leg edema. The patient's medical history is significant for afib, coronary disease, congestive heart for diabetes mellitus, GERD, thyroid disease, sick sinus syndrome with permanent pacemaker. She has undergone CABG, nausea, profound vascular disease, anemia, severe gastroparesis, as well as having had polio, she presents with profound weakness and she is essentially bedbound.

The patient tells me she has been doing reasonably well over the summer. She is still feeling better off of the simvastatin than she was on the simvastatin, which was causing a lot of muscle aching. She feels now that she just has her typical fibromyalgia type of pain, as well as her arthritis pain. She has known osteoarthritis in her right knee, underwent a total knee replacement back in 2011, still struggles with pain in that area. She has been to see Dr. Sastry in the last couple of months, though I do not have a report from that visit. He did some x-rays, which reportedly showed everything was okay and she was recommended to go to physical therapy, which she thinks actually helps quite a bit. When she does the exercises, her knee feels better. The patient also has a history of lumbar spinal stenosis, has been seeing Interventional Spine, has received injections in her back, which she feels are helpful, somewhat. She thinks the physical therapy, which she also had used for her back, helps as well. She has started back with a chiropractor, which she thinks is also very helpful. These pains somewhat limit her exercise, though she tries to walk