Medical Diagnosis of Musculoskeletal Pain Essay
During history taking in musculoskeletal pain, the nurse practitioner (NP) considers the demographic characteristics of the patient and history of illnesses such as arthritis and diabetes. The NP also considers features of pain such as location, severity, aggravating or relieving factors, onset, and duration. The traits to look for in joint assessments include stiffness, stability, swelling, and numbness. Stiffness in the morning suggests the presence of inflammatory arthritis. A patients involvement in sports also needs to be recorded since pain localization implies the involvement of superficial structures. Moreover, the NP ought to focus on systemic signs such as fever, chills, malaise, and weight loss.
The nurse practitioner (NP) employs inspection and palpation techniques in the physical examination of musculoskeletal disorders. The NP inspects for inflammatory signs such as swelling, redness and skin abrasions. It is also vital to perform gait inspection, joint defects and dermatological changes around the ankle joint. The NP feels for soft tissue swellings and tenderness, which are pointers of inflammation.
The main regions of focus during palpation are posterior, medial and anterior aspects of the ankle joint (Porter & Kaplan, 2011). Evaluation of blood circulation around the joint is vital in the determination of vascular involvement, which is a key determinant of the healing process. Establishing a patients response to touch is critical in gauging nerve involvement and cause of pain (nerve compression or trauma). Physical examination includes motion assessment aspects such as active, passive and resistive motions (Smeltzer, Bare, Hinkle, & Cheever, 2010).
Important Diagnostic Tests
Diagnostic tests in the ankles range of motion tests, laboratory blood studies and imaging studies. Motion analysis involves a talar tilt test for , which is positive if there is ankle pain with over the calcaneofibular and anterior talofibular ligaments. The anterior drawer test is positive if the patient has joint laxity of the talofibular ligaments with visible depression during movement (Tierney, McPhee, & Papadakis, 2006). Compression tests assess distal tibiofibular joint strength. Lower leg pain indicates a fracture or syndesmotic sprain, whereas external rotation is helpful in the diagnosis of syndesmotic injuries. Crepitus sounds, conversely, indicate cartilage or tendon involvement (Smeltzer et al., 2010).
Laboratory diagnostic tests involve the analysis of synovial fluid composition and blood tests to investigate rheumatic disease, which is typified by leukocytosis and elevated erythrocyte sedimentation rate. Imaging tests for fractures and other bone malformations include plain ankle X-rays, computed tomography, ultrasonography, and magnetic resonance imaging (MRI). However, MRI is the best test for minute fractures that are invisible to (Smeltzer et al., 2010). Other helpful diagnostic tests include arthrography and bone scanning. Bone densitometry determines bone mass, which is important in the diagnosis of osteoporosis.