Case Study Analysis – 64-year-old Male with Degenerative Disc Disease

Case Study Analysis – 64-year-old Male with Degenerative Disc Disease

The case is of a 64-year-old male presenting with complaints of gradual weakness in his dominant arm. He has had ongoing numbness and tingling starting from his elbow but has been dropping items lately due to weakness. His history is positive for an unmanaged crushing injury to the left thumb four years ago and an unmanaged head injury several years ago. He fell backward, striking his head on the end of a car. Findings revealed a slightly elevated, non-fasting FBS and mild-to-moderate degenerative disc disease (DDD) at C6-C7 with neuroforaminal narrowing and slight impingement of the exiting nerve root.

The manifestations of progressive function loss demonstrated by dropping items due to weakness and peripheral neuropathy demonstrated by numbness in the extremities are common presentations in neurodegenerative disc disease. Neurodegenerative disc disease occurs when the spinal discs wear out. The neuromuscular pathophysiologic principle underlining the development of a degenerative disc disease stems from its anatomy and functionality. The intervertebral disc is composed mainly of the annulus fibrosus and pulposus. Both provide mechanical stability to the spine. In this disease, a progressive decrease in disc activity and the number of discs is apparent. This decrease may be associated with mechanical loading, genetics, and defects in nutritional support. This usually affects the production of proteoglycan, a component of the disc that provides flexibility to the spine (Kos et al., 2019). Over time, collagen metabolism is affected by subsequent alterations in the distribution of collagen. Additionally, the loss of proteoglycans affects the hydtration of the disc, affecting their ability to bear hydrostatic press. An annular bulge then results, consequently compressing the nerve root in the affected area. This can be seen as a neuroforaminal narrowing in the affected spine area (Scarcia et al., 2022). X-ray findings in the case revealed a neuroforaminal narrowing, reflecting the pathophysiological process underlying his suffering.

The neurological pathophysiology of degenerative disc disease is underlined by nerve root compression. In this case, an annular bulging C6-C7 spine results in the neuroforaminal narrowing, slightly impinging the nerve root in the area. C6 provides sensation to the thumbs, while C7 controls sensation to the wrist extensor muscles and the triceps. The functional losses seen on his arm are highly suggestive of a C6-C7 defect. The common manifestations of peripheral neuropathy and muscle weakness are often a consequence of the loss of innervation to the muscular areas. In the case presented, peripheral neuropathy was the focal neuronal sign, while muscle weakness was the predominant neuromuscular sign.

Several factors are known to interplay in the development of DDD and, subsequently, the physiological functioning of these individuals. Genetic and environmental factors have been implicated in the development of this disease. The genetic influence is evident through cytokine polymorphism associated with ethnicity. DDD attributed to mechanical strain has also been found to have an ethnic predilection.

A genetic predilection to DDD coupled with an environmental predisposition to the disease contributes to the development of the disease. In the presence of genetic variables, individuals with family members having the disease are likely to have the disease (Goode et al., 2022). This is because the occurrence of the disease is highly suggestive of cytokine polymorphisms in the family line. Ethno-environmental factors in DDD are mostly seen in DDD attributed to mechanical strains. Ethnic minority groups that tend to be involved in more physically straining jobs are known to suffer more from degenerative diseases of the spine (Goode et al., 2022). Additionally, other sociocultural variables apparent in these groups, such as poor health-seeking behaviour, can contribute to their disease. This may be the scenario in the patient case above. His injuries can be attributed to his falling while at work. The fact that he did not seek any medical attention while downplaying his injuries may be the reason for his current presentation.

References

Goode, A. P., Cleveland, R. J., George, S. Z., Schwartz, T. A., Kraus, V. B., Renner, J. B., Gracely, R. H., DeFrate, L. E., Hu, D., Jordan, J. M., & Golightly, Y. M. (2022). Predictors of lumbar spine degeneration and low back pain in the community: The Johnston County Osteoarthritis Project. Arthritis Care & Research, 74(10), 1659–1666. https://doi.org/10.1002/acr.24643 

Kos, N., Gradisnik, L., & Velnar, T. (2019). A brief review of the degenerative intervertebral disc disease. Medical Archives, 73(6), 421. https://doi.org/10.5455/medarh.2019.73.421-424 

Scarcia, L., Pileggi, M., Camilli, A., Romi, A., Bartolo, A., Giubbolini, F., Valente, I., Garignano, G., D’Argento, F., Pedicelli, A., & Alexandre, A. M. (2022). Degenerative disc disease of the spine: From anatomy to pathophysiology and radiological appearance, with morphological and functional considerations. Journal of Personalized Medicine, 12(11), 1810. https://doi.org/10.3390/jpm12111810

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A 64-year-old male presents to the clinic with complaints of gradual onset of weakness in 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 has been dropping items due to weakness. He denies any recent injuries but states 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 tyre and fell backward, 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.
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as racial and ethnic variables can play a role.

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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 would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How do these processes interact to affect the patient?