A 64-year-old male presents to the clinic with complaints of gradual onset of weakness to the left hand. He is left hand dominant. He has had ongoing numbness and tingling th

Running head: CASE STUDY ANALYSIS 1

Module 5 Assignment: Case Study Analysis

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CASE STUDY ANALYSIS 2

Case Study

64-year-old male presents to the clinic with complaints of gradual onset of weakness

to 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 had been dropping

items due to the weakness. He denies any recent injuries but state 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 tire and fell backwards 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.

Neurological and Musculoskeletal Pathophysiologic Processes

The numbness the patient experiences can be attributed to dysfunction along the

pathway, from the sensory receptors to the cerebral cortex. This can be due to ischemia or

mechanical nerve compression. As a result of the sustained crushing injury to the left thumb

that was not treated, the nerves on the hand might have been injured or negatively affected. In

addition, he also tripped over and fell backward, thus striking his head on the fender of a car.

From this, he might have injured his brain. The patient might have developed vasculitis,

which is inflammation of blood vessels. Vasculitis can affect any blood vessels such as

capillaries, arteries, venules, arterioles, veins, or venules. Further, the patient might have

suffered from ischemic stroke, characterized as sudden neurologic deficits resulting from

focal cerebral ischemic linked to permanent brain infarction (Chin, 2018).

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CASE STUDY ANALYSIS 3

Being more specific and as mentioned above, this patient seems to be suffering from a

dysfunction along the pathway, from the sensory receptors to the cerebral cortex, due to

ischemia or mechanical nerve compression known as Cervical radiculopathy. Cervical

radiculopathy is characterized by neurological dysfunction caused by compression and

inflammation of the spinal nerves or nerve roots of the cervical spine, which has relation to

the patient's x-ray results showing mild-to-moderate degenerative disc disease at C6-C7 with

neuroforaminal narrowing and slight impingement of the exiting nerve root (Kang et al.,

2020). Depending on the segments involved and the severity of neurological dysfunction,

various signs and symptoms of cervical radiculopathy may manifest as neck, and unilateral

arm pain with numbness, weakness, or altered reflexes also related to the patient signs and

symptoms.

Cervical radiculopathy is the pathological process associated with the cervical spinal

nerve or nerve root compression and inflammation. Disc herniation is more commonly

associated with lumbar radiculopathy than with cervical radiculopathy. Disc herniation is

responsible for only 21.9% of cervical radiculopathy cases. Cervical spondylosis, the most

common cause of cervical radiculopathy, refers to degenerative changes resulting from aging

in most adult populations. Disc degeneration with age leads to decreased disc height and

foraminal narrowing. Reduced disc height causes increased loads to the vertebral body and

the intervertebral joints of Luschka (uncovertebral joints). This leads to osteophyte formation

and bony hypertrophy. Hypertrophy of the uncovertebral and facet joints can cause foraminal

stenosis and cervical radiculopathy (Kang et al., 2020).

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CASE STUDY ANALYSIS 4

Racial/Ethnic Variables

Neurologic illness is common among Americans as it affects around 14% of

the general population. The rate is high as people advance in age. For people aged 60 years

and above, the rate is about 19%. This can be attributed to how old age comes with numerous

health issues, including Parkinson's disease and Alzheimer's disease. Since neurodegenerative

diseases suffered in old age negatively affect the brain, they might adversely affect muscles

and other related body parts and organs, thus leading to numbness and weakness in or arms

legs. To prevent many neurological and musculoskeletal health issues, people should get the

needed care early in life (Osmosis.org., 2019). However, while appropriate care is needed in

case of injury as one progresses in age, some racial or ethnic variables make this impossible.

Khan Academy (2019) explained that unequal access to neurologic services is noted for

several neurologic diseases. For instance, people with multiple sclerosis who are black, of

lower-income, physically disabled, living in rural areas, and uninsured are likely to seek the

care of a neurologist. Further, patients with stroke who are female, younger, black, or

Hispanic are less likely to get the needed specialized care from neurologists. It is also notable

that there are delays in diagnosis and symptomatic treatment for neurological health issues

for people with PD who come from low-income backgrounds, are racially monitory, are less

educated, are non-privately insured, or are female.

Determinants such as age, gender, and occupation were significant risk factors.

Prevalence is reportedly 3.5 out of 1000 persons, and gender preferences vary. Individuals are

commonly affected in the 5th and 6th decades of life. The incidence and prevalence rate of

cervical radiculopathy are unclear, and epidemiological data are limited. In a large-scale

retrospective population-based study, the incidence rate was 83.2 per 100,000 people (107.3

men and 63.5 women), with the peak incidence in the fifth decade. A recent US military study

found an incidence of 1.79 per 1,000 person-years.

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CASE STUDY ANALYSIS 5

How the Processes Interact to affect the patient.

When a person comes from a poor background, one would not easily access the

needed care irrespective of how crucial it might be. Many people from poor backgrounds are

only rushed to the emergency departments for health issues that could be addressed with ease

(McCance & Huether, 2019). This is the case of the patient's case study, who is a mechanic

and thus unable to afford his necessities. Based on the type of job he holds, it is possible that

he cannot afford needed care unless it is an emergency. In addition, as a result of his career,

he may have a lower education background. This way, he cannot understand the seriousness

of some health issues. It might be due to the soft education background that he ignored a

knock on the head. He did not think that the injury could negatively affect his brain and lead

to numerous serious health issues.

A patient with C6 radiculopathy usually feels pain or numbness from the neck to the

radial side of the biceps, forearm, the dorsal webspace of the hand between the thumb and

index finger, and to the tips of those fingers. However, CTS usually involves the radial three

and a half digits and manifests by thenar muscle atrophy. The cervical seven nerve root is the

most frequently engaged by cervical radiculopathy. Entrapment of the posterior interosseous

nerve may be mistaken for the motor component of the C7 radiculopathy, causing weakness

of the triceps, wrist flexors, and finger extensors (Kang et al., 2020). However, sensory

changes are absent, and the triceps and wrist flexors have normal strength in posterior

interosseous neuropathy. Usually, when patients explain their symptoms, patients with

cervical six radiculopathy or CTS show the volar side of their hands. Still, patients with C7

radiculopathy often express symptoms by pronating the forearms (Kang et al., 2020).

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CASE STUDY ANALYSIS 6

References

Chin, L. S. (2018). Spinal cord injuries. Retrieved from

https://emedicine.medscape.com/article/793582-overview#a4

Kang, K. C., Lee, H. S., & Lee, J. H. (2020). Cervical Radiculopathy Focus on

Characteristics and Differential Diagnosis. Asian spine journal, 14(6), 921–930.

https://doi.org/10.31616/asj.2020.0647

Khan Academy. (2019). Ischemic stroke. Retrieved from

ttps://www.khanacademy.org/science/health-and-medicine/circulatory-system-

diseases/stroke/v/ischemic-stroke

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in

adults and children (8th Ed.). St. Louis, MO: Mosby/Elsevier.

Osmosis.org. (2019, June 12). Osteoporosis – causes, symptoms, diagnosis, treatment,

pathology [Video file]. Retrieved from https://www.youtube.com/watch?

v=jUQ_tt_zJDo

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