RETROSPECTIVE ANALYSIS OF PATIENT CASE STUDY

Retrospective Analysis of Patient Case Study



Retrospective Analysis of Case Study

In this paper I will be discussing the clinical reasoning processes that I experienced whilst treating a patient in a musculoskeletal outpatients department. A summary of this patient can be found in Appendix 2. The discussion will focus upon critically reviewing the reasoning processes underlying my decision making by focusing on a significant event that occurred whilst treating this patient and the factors which influenced the decision making processes.

24 Year old male recreational windsurfer with no history of previous back problems wakes with a pain in his left buttock area. On the previous 2 days he had had a very bad low lumbar backache. 2 days after onset of the pain in his buttock it spread, overnight, down his left leg with tingling into the big toe area of his left foot. Intervertebral Discs are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. The spinal canal is a hollow space in the middle of the spinal column that contains the spinal cord and other nerve roots. The discs between the vertebrae allow the back to flex or bend. Discs also act as shock absorbers.Normal anatomy of lumbar spine. Discs in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus fibrosus) and an inner gel-like substance (nucleus pulposus). In the cervical spine(neck), the discs are similar but smaller in size. Two layers of cartilage which cover top and bottom aspect of each disc called avertebral end plate. Its separate the disc from the adjacent vertebral body.

Urgent surgery is used to remove bulging disc material that is compressing nerves and causing severe buttock or leg symptoms, before permanent damage is done to the nerves, and the symptoms become irreversible. Sometimes it is necessary to remove the entire disc. In this case, sometimes the back pain does resolve. If after six to twelve weeks of conservative treatment, there are still uncontrollable buttock or leg symptoms, then elective surgery will be considered. Remember, the pressure relieving, or decompressive, surgery can't cure the back pain caused by a torn annulus. This must heal by itself. The purpose of surgery is to remove the nerve compression and reduce the buttock and leg symptoms.

Physical therapies - correct posture, activity modification (avoiding bending, lifting, twisting and prolonged sitting), low impact and flexibility, strength and endurance exercises, hydrotherapy, physical therapy modalities such as heat, ice, massage, and manipulation or mobilization. Medications - early aggressive use of medication to reduce pain, inflammation, muscle spasm and sleep disturbance. Other treatments - ie acupuncture, ultrasound, laser, short-wave diathermy.These treatments provide temporary pain relief, and can help the inflammation and bulging that are causing the pain to settle.

When the forces applied to your back exceed the strength of your discs, minor injuries to the disc can occur. It is important to note these injuries may or may not hurt at the ...