CASE STUDY 1 – CP
A 35-year-old, right-handed male presented to the emergency department with complaint of right upper
arm pain. He was a member of an amateur baseball team; just prior to arrival he threw a ball and
immediately felt a pop and sharp pain in his right upper arm. Since that time, he had been unable to move
his arm due to pain. He reported no prior injury to the arm but did state that over the last several weeks
he had been having an ache in that arm. He was otherwise healthy, took no medications, denied
weakness, numbness and tingling in his right arm. He was a non-smoker and an occasional drinker. He
used no drugs.
Physical exam was non-focal except for the right upper extremity. His right upper arm was swollen and
tender to the touch. He had decreased range of motion in his elbow and his shoulder secondary to the
pain. He had an obvious deformity of the right bicep region. Distally the patient was neurovascularly intact
with normal range of motion and light touch sensation intact in the wrist and hand. He had a 2+ radial
pulse and capillary refill was less than 3 seconds.
CASE STUDY 1 – CP
Subjective
Objective
Assessment
Plan
CASE STUDY 2 – TS
A 52-year-old white female has been experiencing bone pain over the past several years after
menopause. She states, “The pain is becoming worse, and it is keeping me from doing my daily
activities.” She currently complains that any weight-bearing activity causes her severe discomfort. She
now reports having “hot spells” at different times throughout the day with some trouble sleeping for the
past 3 months. She also complains of some vaginal dryness that she admits is bothersome.
She is not taking any medication. She has been using a soy herbal supplement and vitamin E 400 IU
daily. She is up to date on all her gynecological exams, and past mammograms have been normal as
have her health maintenance exams. She does not smoke or use alcohol. Her system reviews are
unremarkable excluding today’s complaint. She lives alone in a one-story house and works at a car plant.
She has three children and one grandchild. Her daughter lives in close proximity to her so she is able to
enjoy visiting and caring for her 3-year-old grandson occasionally. She has no exercise routine and
admits to a somewhat sedentary lifestyle. She admits to eating a vitamin-poor diet.
CASE STUDY 2 – TS
Subjective
Objective
Assessment
Plan
CASE STUDY 3 – L.P.
L.P is a 5-year-old girl, born by Caesarean section for fetal macrosomy (birth weight 4520 g), without any
perinatal problems. She was exclusively breast fed until 6 months of age, then switched to formula milk.
Since the age of 2 years LP has been complaining of recurrent hip pain and the mother reports that the
infant does not walk normally. The orthopedist prescribes corrective insoles as he noticed valgism of the
knees and foot pronation. Due to the persistence of these signs, the girl undergoes a radiological
examination which shows bone deformations and osteopenia. After 2 years a deflection in the growth
curve is noted and the child is sent to your specialist outpatient clinic. She is sent without any radiological
or laboratory documentation. Upon clinical examination you notice a prominent forehead, valgism of the
knees and brevity of the limbs.
CASE STUDY 3 – L.P.
Subjective
Objective
Assessment
Plan