NU606 ASSIGNMENT-MUSCULOSKELETAL

Each response must have a reference, including at least two

scholarly references other than your textbook or course materials.
Your answers should comprehensively address the questions posed.
You may use the same reference more than once if appropriate.

Mrs. Johnson has returned for another visit. She reports that she has
recovered from her sinus infection and feels much better. However, today, she
states that she is having increasing right shoulder pain over the past couple of
weeks. She explains that her shoulders have “always bothered” her because
she worked in a factory moving boxes for years. She states that she uses
naproxen, “prescription strength,” and that usually does the trick when her
pain flares up, but she is out and would like a refill.

1. In a patient Mrs. Johnson’s age, what conditions or disorders could

cause shoulder pain as she describes? Identify three and explain your
rationale.

In a patient Mrs. Johnson’s age, the following conditions or disorders could

cause shoulder pain as she describes:

a. Rotator Cuff Impingement

One common cause of shoulder pain is an impingement of the

rotator cuff. This occurs when the rotator cuff tendon and the subacromial
bursa are pinched in the subacromial space, resulting to inflammation and
swelling. Repetitive movements and old age are common causes of rotator cuff
impingement. Overhead movements of the shoulder joint aggravate the
impingement.
Reference: New Health Advisor. (2020, April 8). What Is and How to Treat Rotator Cuff
Impingement? https://www.newhealthadvisor.org/Rotator-CuffImpingement.html

b. Osteoarthritis

The most common type of arthritis in the shoulder is

osteoarthritis. Osteoarthritis takes time to improve, and the pain gets worse
over time. Swelling, discomfort, and stiffness are common symptoms that
appear in middle age. To alleviate arthritis pain, avoiding shoulder
movements can result in a tightening or stiffening of the soft tissue sections of
the joint.
References:
- OrthoInfo. (n.d.). Shoulder Pain and Common Shoulder Problems - OrthoInfo - AAOS.
https://Orthoinfo.Aaos.Org/En/Diseases--Conditions/Shoulder-Pain-and-Common-Shoulder-
Problems
- Illnesses & conditions, NHS inform. (n.d.). Arthritis symptoms and treatments. Retrieved May 1,
2021, from https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/
conditions/arthritis

c. Bursitis

Bursitis is a condition in which the tissue-thin sacs of fluid that cushion

the bones, tendons, and muscle in a joint, also known as a bursa, become
inflamed. Bursitis creates a dull ache that worsens when you raise or move
your arm away from your body. The pain is often caused by constant motion,
according to J.Scott Quinby, M.D. It can also happen on its own.
References:
- AARP. (n.d.). Shoulders Hurt - Common Causes of Shoulder Pain. Retrieved May 1, 2021, from
https://www.aarp.org/health/conditions-treatments/info-05-2013/common-causes-of-shoulder-
pain.html
- Quinby, J. S., M.D. (n.d.). Bursitis. https://www.Aarp.Org/Health/Conditions-Treatments/Info-05-
2013/Common-Causes-of-Shoulder-Pain.Html.

2. Explain how a medication like naproxen may interrupt the

pathophysiology of one of those conditions and help reduce pain. In
other words, how does the use of that medication return Mrs. Johnson
to a more homeostatic state?

Naproxen and other nonsteroidal anti-inflammatory drugs

function by lowering hormones in the body that cause inflammation and
pain. It's used to treat arthritis, tendinitis, bursitis, and other disorders
that cause pain and inflammation. Naproxen may also be used to relieve
the acute pain caused by conditions other than those stated previously.

Naproxen restores Mrs. Johnson's homeostatic balance by

inhibiting the enzyme that produces prostaglandins, the substances that
cause pain and inflammation.
 References:
- Drugs.com. (n.d.). Naproxen Uses, Dosage, Side Effects & Warnings. Retrieved May 1, 2021,
from https://www.drugs.com/naproxen.html
- MedicineNet, & Ogbru, O. (2019, February 27). Naproxen (Aleve) Side Effects, Dosage &
Interactions.
https://www.medicinenet.com/naproxen/article.htm#what_is_naproxen_and_how_does_it_
work_mechanism_of_action

On exam, you note that her right shoulder is tender to palpate, and she has
limited range of motion. She smells of BenGay but, otherwise, she seems
healthy. There still have not been any medical records available for review.
The area is edematous, and when asked, she does agree that her arm seems
swollen. She denies any falls but remembers that she lost her balance and fell
backward into her recliner a few days ago “kind of hard” but she caught
herself when she grabbed for the coffee table. Otherwise, she does not recall
any injuries. You decide to send Mrs. Johnson for an x-ray and she is in the
waiting room until you get the results back.

The following radiograph (image 1) is what is sent to you via teleradiology.

3. The x-ray indicates a pathological fracture of her humerus. What is a
pathological fracture?
A pathologic fracture is a bone fracture caused by a disease rather
than an injury. Bones, for the most part, need a cause to crack, such as a
severe injury. Some situations, on the other hand, weaken the bones,
making them more prone to breakage.
References:
- The Spine Hospital at The Neurological Institute of New York, Mccormick, P., Angevine, P.,
Mandigo, C., & Reid, P. (n.d.). Pathologic Fracture. Retrieved May 1, 2021, from
https://www.columbiaspine.org/condition/pathologic-fracture/
- Healthline. (2018, September 18). Pathologic Fracture: Symptoms, Causes, and Treatment.
https://www.healthline.com/health/pathologic-fracture

4. What can cause a pathological fracture? Be specific.

The two most common causes of pathological fracture are

osteoporosis and cancer (resulting in a tumor). Osteoporosis is a bone-
weakness and brittleness disease that affects older women primarily.
Back pain, hunched posture, progressive height loss, and fractures are
symptoms of osteoporosis. Cancer is a disease characterized by
abnormal cell formation. Tumors may arise in the vertebrae or be the
product of cancer spreading from another part of the body. The term
"metastasis" refers to the spread of cancer. Metastasis frequently occurs
in the vertebrae.

References:
- The Spine Hospital at The Neurological Institute of New York, Mccormick, P., Angevine, P.,
Mandigo, C., & Reid, P. (n.d.). Pathologic Fracture. Retrieved May 1, 2021, from
https://www.columbiaspine.org/condition/pathologic-fracture/
- Healthline. (2018, September 18). Pathologic Fracture: Symptoms, Causes, and Treatment.
https://www.healthline.com/health/pathologic-fracture
- Gilmore Health News. (2021, March 27). The Cancer Diagnosed Today Did Not Just Start
Yesterday According to Study. https://www.gilmorehealth.com/the-cancer-diagnosed-
today-did-not-just-start-yesterday-according-to-study/
- Biology Discussion. (2017, May 17). Essay on How Cancers Spread ?: Types: Diseases:
Biology. https://www.biologydiscussion.com/essay/cancer-essay/essay-on-how-cancers-
spread-types-diseases-biology/78508
5. Assuming you had access to Mrs. Johnson’s medical records, what
history or risk factors would you be looking for that could predispose
her to an injury of this sort.

If I had access to Mrs. Johnson's medical records, I would be

looking into possible circumstances where she might have strained or
injured her shoulder. Considering that she worked in a factory involving
moving boxes for years, straining and injuring her shoulders is most
likely to happen.

6. Identify three interventions that can promote healing of a pathological

fracture. Explain how these interventions will help return Mrs. Johnson
to a more homeostatic state.

a. Taking pain medications - Treatment for osteoporosis may help

avoid more fractures if the disease causes the fracture. Calcium and
vitamin D supplements, bisphosphonates, and weight-bearing activity
are also possible treatments.

b. Limiting physical activity – Limiting physical activity improves

recovery by ensuring flexibility and reducing the risk of disrupted
alignment and muscle spasms.

c. Wearing a brace - The brace supports the back and prevents

forward bending, alleviating strain on the broken vertebrae.

References:
- The Spine Hospital at The Neurological Institute of New York, Mccormick, P., Angevine, P.,
Mandigo, C., & Reid, P. (n.d.). Pathologic Fracture. Retrieved May 1, 2021, from
https://www.columbiaspine.org/condition/pathologic-fracture/