Scenario (Case Study): “A 64-year-old male presents to the clinic with complaints of gradual onset of weakness to the left hand | Homework Solution
Table of Contents
Table of Contents
Scenario (Case Study):
“A 64-year-old male presents to the clinic with complaints of gradual onset of weakness to the left hand. He is left hand dominant. He has had ongoing numbness and tingling that feels as though it starts at his elbow. However, over the past 2-3 days he had been dropping items due to the weakness. He denies any recent injuries but state that he sustained a crushing injury to the left thumb 4 years ago. He is employed as a mechanic. Several years ago, he tripped over a tire and fell backwards striking his head on the fender of a car.
He didn’t seek medical attention because he only had a small scrape on his elbow. A CT of the head is within normal limits and all labs are normal with the exception of a slightly elevated, non-fasting blood sugar (135). He has no history of diabetes. An x-ray of the neck reveals mild-to-moderate degenerative disc disease at C6-C7 with neuroforaminal narrowing and slight impingement of the exiting nerve root.”
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To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
SAMPLE ANSWER
Certainly, let’s dive deeper into each aspect of the case study analysis comprehensively:
Neurological Pathophysiology:
The patient’s symptoms of weakness, numbness, and tingling in the left hand, starting from the elbow, suggest involvement of the peripheral nerves, specifically those originating from the cervical spine. The history of a crushing injury to the left thumb and a fall onto the head raises concerns for nerve damage or compression.
- Peripheral Nerve Compression: The mild-to-moderate degenerative disc disease at C6-C7 with neuroforaminal narrowing and slight impingement of the exiting nerve root is a significant finding. The narrowing of the neuroforamen, which are the passageways through which the spinal nerves exit the spinal cord, can result in compression or irritation of the nerves. This compression may affect both motor and sensory functions of the nerves.
- Motor Dysfunction: Compression of the nerve roots at the C6-C7 level could lead to weakness in the muscles innervated by these nerves. In this case, the weakness is noted in the left hand, which is consistent with the distribution of nerves affected by the compression.
- Sensory Dysfunction: Numbness and tingling starting at the elbow suggest involvement of sensory nerves. When the nerves are compressed or irritated, they may transmit abnormal signals, leading to abnormal sensations like numbness and tingling along their distribution.
- Chronicity: The gradual onset of symptoms implies a chronic process rather than an acute injury. Chronic compression of nerves can lead to progressive damage over time, resulting in the gradual onset and worsening of symptoms.
Musculoskeletal Pathophysiology:
Degenerative disc disease involves the breakdown of intervertebral discs, leading to structural changes in the spine. In this case, the degeneration is noted at the C6-C7 level.
- Disc Degeneration: Degenerative changes in the intervertebral discs can lead to a decrease in disc height and integrity, resulting in narrowing of the space between the vertebrae. This narrowing, along with the formation of osteophytes (bone spurs), can contribute to the compression of nearby nerves.
- Neuroforaminal Narrowing: As the discs degenerate and the space between the vertebrae decreases, the neuroforamen through which the spinal nerves exit may become narrowed. This narrowing can further contribute to nerve compression and impingement.
Racial/Ethnic Variables:
While not explicitly mentioned in the case study, it’s important to recognize that certain racial and ethnic groups may have differences in the prevalence or severity of musculoskeletal and neurological conditions. For example, some studies have suggested variations in the prevalence of degenerative disc disease among different racial and ethnic groups. Additionally, genetic factors may play a role in predisposing certain populations to specific musculoskeletal or neurological conditions.
Interaction of Processes:
The neurological and musculoskeletal processes interact in this case to produce the patient’s symptoms. The degenerative changes in the cervical spine, specifically at the C6-C7 level, lead to narrowing of the neuroforamen and compression of the exiting nerve root. This compression results in both motor and sensory dysfunction, manifesting as weakness, numbness, and tingling in the left hand. The chronic nature of the degenerative process accounts for the gradual onset and progression of symptoms over time.
In conclusion, the patient’s symptoms are likely a result of the interaction between neurological and musculoskeletal pathophysiological processes, specifically nerve compression due to degenerative disc disease at the C6-C7 level. Understanding these processes is crucial for the diagnosis and management of the patient’s condition.
