Chief Compliant: Mrs. Lin Zhang is a 52-year-old Chinese-American woman who presents with chronic lower back pain, bilateral knee stiffness, and intermittent radicular symptoms in her right leg.
History of Present Illness: She reports that her back pain has progressively worsened over the past three years and is aggravated by prolonged standing and walking. The pain radiates down to her calf after long hours on her feet and is described as a dull, aching pressure with sharp flare pain after activity, with radiculopathy traveling down to her toes (see dermatome map). She also has difficulty bending, squatting, and getting up from chairs.
(Review her areas of concern below and follow the dermatome for better understanding of her symptoms and the pathway of pain, numbness and weakness.)
Social History: Mrs. Zhang owns and operates a busy Chinese restaurant where she works long hours—typically 10–12 hours per day—on her feet with limited breaks. She used to walk daily for exercise but can no longer tolerate physical activity due to worsening knee pain and lumbar discomfort.
She has gained 25 pounds in the last year. Her BMI is 31.6.
Medications: Acetaminophen
She has not seen a specialist due to time and cost constraints. Her family history includes back problems in her father and knee arthritis in her mother.
Physical Exam: Decreased lumbar range of motion, paraspinal muscle tightness, positive straight leg raises on the right, and crepitus in both knees.
Diagnostics: MRI imaging reveals lumbar spondylosis with foraminal narrowing at L5-S1, and bilateral knee osteoarthritic changes, including joint space narrowing and osteophyte formation.
Case Study Analysis – Due Sunday, July 20th.
Develop a 2-page case study analysis, examining the patient symptoms presented.
1) Explain the musculoskeletal pathophysiologic processes of why the patient presents these symptoms.
2) Explain how obesity plays a role in the progression of osteoarthritis in the knee joints.
3) Explain risk factors that may contribute to the development of the disease.
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