is it the SKY ATTIC AH?

Haha! not really sure what this weeks PCL is about but im guessing its sciatica (hence sky-attic-ah)...

Here's what we can collect from the passage:

Name: Adnan Huskic
Age: 43 years old

Occupation: Currently working as a self-employed taxi driver. Use to work as a veterinarian and cattle treater. (Highlights occupation as one of the risk factors for musculoskeletal and nerve problems)

HPI.

When: Has history since 10 years ago and recently on one Saturday night which lasted till the following Monday. Discomfort increased within 48 hours of occurrence of pain.

Where: Pain is his lower back and right leg.

Quality: Sharper than usual. Sever and persistent(48 hours later)

Quantity: No indication but however has gotten worse within 48 hours of occurrence of pain.
Alleviating: He thought that warm things eg. hot drink, hot water bottle, warm bed and walking occasionally would ease the pain but it DID NOT EASE IT.

Aggravating: Long periods of sitting, lifting heavy suitcases.

Associated Symptoms: Pain spread from the leg to back of right leg into his foot.
+

Beliefs: No beliefs were apparent from the passage.

PAST MEDICAL HX.

Past Medical Hx: Nagging lower back pain since ten years ago. Apart from that seems healthy.
Past Surgical Hx: -

Hospitalizations: -

FAMILY, DRUGS, ALCOHOL, SEXUAL HXx - Not Known.

Social HX.

Occupation: As mentioned earlier, he works as a taxi driver. He works for 60 long and stressful hours a week. ): Both his past and present jobs required him to move heavy objects.

Travel: Because of job, he travels here and there in taxi. Latest to Taiping. Out of country known although he has been in Bosnia.

Migration: Moved from Bosnia 8 years ago.

Family: Has 3 children with wife Ziba, that works as a cleaner in private hospital.

Financial: Hard to make ends meet. Wife does not make much either.

Discussion Points.

Sociological Issues:

a) The occupation as a risk factor ie. involved in pathogenesis of medical condition.

b) Stresses of migrating and settling down in a new country.

c) Financial burdens as one of the stressors faced by people. Ie. Adnan felt worried bout it affecting his work.

d) Financial help or assistance for these people?

Others:

a) Limit of working hours for normal working people?

b) Normal remedies for treating backaches.

Differential Diagnosis:

a) Osteoarthritis - Bony spurs causing compression of nerves

b) Herniation of Intervetebral Disc

c) Torn ligament due to hyperflexion or hyperextension

d) Muscle tear or pulled muscle

e) Sciatica

f) Piriformis Syndrome

g) Osteoporosis

h) Tumor

i) Trauma

j) Fracture of the bone (spine) and compression fracture (JUST learned that from Grey's Anatomy)

k) Osteomyelitis

l) Vascular complications

m) Mutiple Sclerosis

n) Avascular necrosis bone

o) Ischemic conditions causing necrosis of muscle

p)Cauda Equina Syndrome

q) Spondylolisthesis

All these were the diagnosis that I could come of with. Note that most of this can actually lead to sciatica. However, in diagnosis a patient, sciatica might be a complication that arises from an underlying medical condition. So in this case, it is wise to explore all the possible options including those that are involved in the aetiology of sciatica.

Now that I think that the problem might be sciatica, here's some sources about it.

Since we need a authoritative, accurate, current and objective source, here's once from JAMA.
A little simple explanation from them about sciatica (:

http://jama.ama-assn.org/cgi/reprint/302/2/216.pdf

One from Medline, http://www.nlm.nih.gov/medlineplus/sciatica.html

There's also a specific syndromes called the piriformis syndrome and the cauda equina syndrome. Basically also sciatica but sciatica can be due to a host of reasons.

http://www.ninds.nih.gov/disorders/piriformis_syndrome/piriformis_syndrome.htm

http://www.emedicinehealth.com/cauda_equina_syndrome/article_em.htm

Whether or not this is caused by a host of different reasons, it is safe to say that it is most likely sciatica, which is a condition for compressed sciatic nerve. This few correlations tell why:-

Why this may be a neurological condition, the very mere fact that the pain goes from the back to his leg and radiated to his foot indicates that the pain is caused by a part of the body that is connected to all these regions. According to as much as i know, I don't think any muscles stretch that long all the way down to the foot. Only nerves and blood vessels has this connection. Given that we are dealing with pain, it is most likely involving the nerves being irritated and compressed. Since the pain is not superficial, we can assume this involves direct pain on the nerve which are deep and not the superficial eg subcutaneous ones.

Pain on lower back which radiates all the way down to his foot. The sciatic nerve is one of the major nerve that supplies the lower limbs. Most important and most likely to be compressed.

The pain is only on one of his leg. Sciatica may usually occur sometimes as a unilateral pain.

Adnan is in a suitable age at risk for sciatica. Age risk is from 30-50 years old. This also spells the risk for possible degenerative arthritis which may result in sciatica.

Given that Adnan lifts heavy things, he has the tendency to cause a ruptured ligament or IV disc. This also points towards sciatica.

Given that the pain got worse and that normal remedies such as rest and hot water bottles do not work, it may seem like the pain is not caused superficially at the muscles but in the deeper regions involving the spine, nerves or ligaments.

SO YEAH, thats my two cents for this coming weeks PCL. Remember to READ TALLY O' CONNOR for DR. ARUL'S session and DO ANATOMY FOR THIS COMING WEEK!!!!

Enjoy the holidays, or what's left of it (: