Discussion: Assessing Muscoskeletal Pain

 Focused SOAP Note for a patient with knee pain
S.
CC “Knee Pain”
HPI: The patient is a 15-year old male who developed pain in both knees. The patient describes the pain as a “catching sensation” which occurs in the patella region. Getting information on the onset of the pain is imperative. Additionally, it is important to get information on the type of activity the patient indulges in for example, which sport the patient participates in or whether the pain was triggered by an event that occurred, for example, an accident.
Current Medications: The patient should indicate the whether he is on any medication to help rule out drug-induced diseases. It is also essential to inquire about whether they have been hospitalized in the past for a musculoskeletal condition and whether any medication was administered.
Allergies: It is important for the patient to mention whether they have any allergies to medication or food. The importance of noting allergies is to avoid hypersensitivity to some medication which may be fatal.
PMHx: The patient should mention the occurrence of any previous musculoskeletal condition and the time it occurred. Soc Hx: The patient should mention their occupation. Further, he should also mention whether they use any recreational substance such as alcohol or tobacco. It is important to investigate the physical activity of the patient in the last three months.
Fam Hx: For this specific case, the patient should mention any musculoskeletal conditions that may be present in the immediate family or grandparents.

The aim is to understand whether there may be a genetic link in the condition (Fernández-de-las-Peñas, Cleland, & Dommerholt, 2016).
ROS:
GENERAL: A check on the temperature and appearance of the patient. Indicate if fatigued or maybe having chills.
HEENT: An analysis if the appearance of the eyes, ears and nasal function. Indicate in the instance where the patient may present abnormal characteristics.
CARDIOVASCULAR:  It is important to check the occurrence of chest discomfort.
MUSCULOSKELETAL:  Analysis if the joint pain in the knee area. It is also important to check whether the patient may be experiencing any problems with other joints.
O.
Physical exam: Firstly, the knees should be thoroughly investigated. The alignment should appear normal, and the angle ranges below 15 degrees. There should also be an examination of any tenderness around the tibiofemoral joint space. The same area should be analyzed for swelling. Further, the motion range should be examined, and the pain experienced graded. The analysis of the pain can be assessed s the patient tries to move the legs (Magee, 2014).
Diagnostic results: An x-ray may be necessary for the investigation of the knee pain experienced by the patient. An MRI may also be done to help observe the state of the knee. An analysis of the information provided should be analyzed, and a diagnosis is made based on the characteristics presented. Consideration of the patient’s history also helps in making a definitive diagnosis and ruling out conditions such as inherited musculoskeletal conditions (Katz et al., 2011). Determination of the management is based on the diagnosis. Both pharmacological and non-pharmacological approaches can be employed in assisting the patient recover from the condition experienced.
Diagnoses:
Chondromalacia of the patella- This condition occurs in patients who are active in sports that stress the knee. It mostly affects young adults and adolescents which makes it significant for this case study.
Lateral compression syndrome- This condition is also common in patients who are young and are physically active. It is characterized by pain which occurs on knee flexion. The patient may have difficulty in descending stairs. The pain is localized to the inferomedial patella (Katz et al., 2011). Quadriceps tendinitis- This is a condition that may occur while undertaking weight-bearing activities. It is also commonly observed in accidents. The condition also presents in patients who participate in sports that involve jumping and sprinting. Although the pain in this condition occurs mostly above the knee, the pain may radiate to the lower part of the knee below the patella (Magee, 2014).Patella maltracking – This condition is characterized by an imbalance of the muscles attached to the knee that include the vastus lateralis and the vastus medialis. This condition mostly occurs in patients who have had accidents where the leg has been injured. The patient experiences pain during movement of the affected leg. An x-ray or MRI will provide information to distinguish it from dislocation (Magee, 2014).
A.
Differential Diagnoses
A list of any other possible conditions can be listed down. These conditions may have similar symptoms to the diagnosis due to having a similar manifestation in patients. It is important to note these differential diagnoses in instances where the management for the primary diagnosis fails.

References
Fernández-de-las-Peñas, C., Cleland, J., & Dommerholt, J. (2016). Manual therapy for musculoskeletal pain syndromes: An evidence- and clinical-informed approach. Kidlington, Oxford: Elsevier.
Katz J., Lyons N., Wolff L., Silverman J., Emrani1 P., Holt H., Corbett K., Agustin Escalante A., and Losina E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12:78, 1-8. Retreived January 15, 2018 from Biomedical.com database.
Magee, D. J. (2014). Orthopedic physical assessment. St. Louis, Missouri: Elsevier.