The Case Study of Cuboid Metatarsal Arthritis and Tendonitis

The case study report concerns an elderly woman who suffers from Cubo-metatarsal arthritis and tendonitis. She came to have an x-ray of her swollen right foot which is also in pain. The disease, arthritis, causes inflammation at different joints in the body and tendonitis is the inflammation of tendons in the body.

I have chosen this particular case since it involves the topic of inflammation which we have covered in the course study, HMI 104. Having covered different types of inflammations, this case study features arthritis, a chronic inflammatory disease which in this case has affected the patient's cuboid metatarsal area. Also, medical imaging is a useful tool for caring with patients with inflammations as in this case.

Professionalism, Patient Care and Ethics

For any medical practice, it is a fundamental requirement that the medical expert conducts themselves within the expected ethical standards while demonstrating professionalism in their duties. Skilful care delivery is an important factor in the quality of medical service rendered to a patient; this means that a medical expert should possess skills centred on quality care for the patient. In this case, the Medical Imaging Technologist exhibited professionalism and quality care-centred skills in the interactions with the patient and other practitioners; this implies the attitude, communication and procedures used during service delivery.

Patient-Practitioner Interactions

In the interaction between a patient and a practitioner, communication is the most important aspect. Research shows that patients are more satisfied with how they communicate with the medical expert than any technical or medical procedure that may be involved (Fong-Ha and Longnecker 39). Therefore, a medical practitioner should be able to listen to the expectation of the patient, explain every procedure in simple comprehensive language and inform them of all involved procedures. Moreover, patience and empathy are important features of a medical practitioner. Nonetheless, the patient has a role to play in this interaction; they are expected to provide the right information, this means all relevant information required for the treatment process.

The Medical Imaging Technologist was empathetic to the patient. Empathy implies sensitivity to another person’s experience; that one is able to understand what another person is feeling or going through. With empathy, the MIT is able to understand the patient’s pain due to the inflammation and hence handle her carefully.

On communication, the MIT explained the procedure and its importance to the patient. Through this, the patient knew what to expect and became more relaxed and comfortable making the procedure as efficient as possible.

Practitioner-Practitioner Interactions

The way a medical practitioner interacts with colleagues shows their professionalism and skills. Respect is a fundamental character among practitioners considering that every expert has a specific role to play. Through respect, harmony is created and the quality of care delivered to a patient is enhanced. In this case, the Medical Imaging Technologist demonstrated respect to others including the supervisor.

Secondly, working as a team also increases the efficiency of any procedure in medicine; this means that one should be able to ask for help when there is a need and make consultations in case of uncertainties. In this case, the MIT demonstrated professionalism by seeking the supervisor's help when he needed to.

Pathology and Pathophysiological Processes

In this case, the patient’s right leg was swollen and showed signs of pain at the particular affected area. The patient suffered a chronic type of inflammation in the joint, arthritis, and in the tendons that connect the bones to the muscle, tendinitis or tendonitis.

Arthritis is an inflammatory disease that affects the joints of any part of the body. There are different types of arthritis depending on the location of the affected area. In this case, the affected area is the lateral part of the foot on the cuboid bone which links the foot to the ankle, one of the tarsometatarsal joints. The type is known as cuboid metatarsal arthritis. It is characterized by swelling and pain in the affected area which makes movement difficult for the patient (Arthritis Foundation: What is Arthritis).

An erosion or degeneration of the ligaments in joints leads to the destruction of the joint and arthritis. Arthritis may be caused by different factors like inflammation and degeneration of joint cartilage. Inflammation occurs when inflammations generated by the body's immune system erroneously strikes the joint causing erosion. Degenerative arthritis occurs with cartilage deterioration leading to lack of cushion between bones and hence the swelling and pain experienced by the patient. The most common degenerative form of arthritis is known as osteoarthritis.

Tendonitis or tendinitis is an inflammatory disease that affects the tendons that connect the bone to the muscle. It occurs due to many factors like excess movements e.g. due to sporting activities. Its occurrence with arthritis is due to the factor of joint deformity which that creates some form of stress on tissues. Arthritis does not only affect body joints, but also the ligament and tendon tissues around the joint; this, in turn, causes the occurrence of tendonitis (Arthritis Foundation: Tendinitis).

Due to excessive and atypical use of tendons, the sheaths become inflamed and swell causing pain especially during movement and swelling of the affected area. When the sheath swells, the tendons’ functional mechanism is limited and hence become stiff along the affected area. For this reason, further movement increases pain in the affected leg area like in the patient’s case.

Research indicates that risk factors associated with osteoarthritis include age, weight and gender. Older people are prone to the disease that young people; in fact, an affected person experiences severity as they age. Additionally, women are more susceptible to the inflammatory disease compared to men (Arthritis Foundation: What is Arthritis). With arthritis as a risk factor, a patient becomes susceptible to tendinitis. The severity of tendonitis is propagated by motion without sufficient rest. Continuous engagement of activities that trigger inflammation in the lower tarsal region could have increased pain for the patient (Arthritis Foundation: Tendinitis).

Due to osteoarthritis and tendonitis, the patient’s mobility capability became limited due to the pain at the joints and due to the tendons. The shape of the metatarsal region was also affected due to deformities caused by the swelling caused by the disease. Deformities in the affected area is an initial sign of arthritis with tendonitis (Belagaje and Ouzounian). With the progression of the disease, a patient may develop the flatfoot deformity even as tendons are affected and the bones reposition out of their usual positions.

Imaging

In this case, the x-ray radiographic technique was used to examine the patient’s right foot. X-ray is the most efficient technique as it creates the required images using shorter wavelengths which is safe for patients. Through an x-ray examination, levels of deformities caused by arthritis or even a probable occurrence of arthritis can be identified.

The Principle of Radiation Biology and X-Ray Imaging

During practice, it is important that a set of guidelines or rules are established and followed to ensure quality care provided to patients. Notably, every imaging department has its own protocols to follow. In radiography, there are principles that guide the protocols established for effective application. The X-ray and gamma are examples of ionizing radiations, non-particulate in specific (Mehta 1237). In order to ensure quality application of the required protocols during imaging, it is necessary that the effects of ionizing radiations in the body tissues of the patient are understood and considered. X-rays are highly penetrative into the human body compared to other forms of ionizing radiations due to their high energy. With their penetration, they may reach genetic material in the body and damage it; they may also affect the body cells. However, the probability of damage is low since the vulnerable genetic material is of small volume compared to surrounding cell environment. Additionally, radiobiological reports indicate the presence of protective mechanisms within cells that protect against ionizing radiation.

The x-ray technique is based on the principle ionization to produce the required images. A beam of x-ray radiations is passed across the affected body area of the patient. The radiations that pass through the body form a pattern that is transmitted to a radiographic film where a chemical reaction occurs and an image is produced (Medical X-ray Imaging). In the process, some radiations are absorbed in the patient’s body as some pass through to create the images. In radiography, a single image is produced to be evaluated later. In other forms of imaging like the CT, various dimensional images are created as the detector is passed about the patient’s affected area (Medical X-ray Imaging). The radiographic film used in x-ray is chemically coated with silver bromide which absorbs the radiations and forms a chemical reaction which allows the formation of the image on the film.

During imaging as a medical practice, there are safety procedures that should be followed. To begin with, there should be a protection protocol that gives guidelines on ways to protect the patients and the technologist during a procedure. Most national legislation requires a quality assurance program for various imaging departments. As a safety measure, safety materials should be provided for both the patient and the imaging technologist e.g. aprons or gloves.

Benefits, Limitations, and Risks of X-ray Imaging

The use of x-ray imaging in medical procedures has benefits, risks, and limitations associated with it. To begin with, x-ray imaging is a painless procedure and, therefore, a patient who is already in pain like in this case doesn’t have to go through more devastating experience during treatment. With x-ray imaging, the cartilage between bones and the shape and position of joints can be viewed making it easier to identify arthritis in the patient’s body.

The use of x-ray imaging in medicine is limited by the dimension of images produced as it generates 2-dimensional images. With the need for further examination using 3-dimensional images, x-ray imaging would not be appropriate. There are risks associated with x-ray imaging which directly involves the use of the ionizing radiations; they include the development of cancer cells with frequent exposure to x-ray radiations, and destruction of genetic material in the body (Medical X-ray Imaging).

In this case, x-ray imaging was used to examine osteoarthritis on the patient’s foot. The report from the doctor after examining the radiographic imaging results indicated that the disease shifted to a severe state. Through imaging, the doctor was able to match the results with clinical symptoms and make a diagnosis. For this, the MIT’s scope of practice is of great importance. The Medical Imaging Technologist is proficient in using the x-ray equipment to acquire the required images. The MIT is also able to determine the best position and safest movement for the patient in order to take the image.

Future Directions

In this case, the patient was diagnosed with severe osteoarthritis on the cuboid metatarsal region of her right foot from previously having a mild form of the disease. Therefore, there is an obvious need for future imaging for the patient. An ultrasound would be necessary for a further examination of the tendons around the affected area. In cases of severe osteoarthritis, ultrasound is useful in detecting joint inflammation along with other anomalies of the bone area. The benefit being that ultrasound does not use any form of radiation. In case of frequent imaging procedures, ultrasounds are also less costly compared to other forms of imaging (Hayashi, Roemer and Guermazi 167).

Further imaging might be useful for future treatment processes. For example, MRI imaging may be used to obtain a three-dimensional view of the affected which is useful in determining the progression of the disease. Compositional MRI may help determine biochemical contents around the joint area which may help doctors plan for further treatment and determine the progression of the disease and identify risks associated with the disease development (Hayashi, Roemer and Guermazi 167).

Osteoarthritis Progression

With osteoarthritis progressing to severe from mild means that there is increased destruction of the cartilage between bones. With time, the cartilage may be eroded and movement will cause a bone to bone unprotected interaction. The shape of the joint may be altered in the process, leading to deformities in the metatarsal area of the patient's right leg. Other tissues around the joint are also affected like the tendons and ligaments. Ligaments may contract to create a deformed shape and cause muscles around the area to weaken (Belagaje and Ouzounian).

As patients age, cases of osteoarthritis are known to get worse. However, this is not the case for the major percentage of patients. For some, the disease severity alleviates especially when the required instructions and procedures from the doctor are followed. Additionally, severity varies with the joints affected (Belagaje and Ouzounian). In this case scenario, the severity of the patient’s illness may have increased due to various risk factors as age, weight or location of the joint. If the risk factors are not considered promptly for action to be taken, the patient may end up experiencing even more severe osteoarthritis which may lead to permanent disability. Nonetheless, there is the Joint Replacement Surgery procedure that may provide a longstanding solution for the patient (Arthritis Foundation: Osteoarthritis Treatment).

Works Cited

Arthritis Foundation: Tendinitis. 2018. ONLINE: https://www.arthritis.org/about-arthritis/types/tendinitis/. October 2018.

Arthritis Foundation: What is Arthritis. 2018. https://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php. October 2018.

Arthritis Foundation: Osteoarthritis Treatment. 2018. ONLINE: https://www.arthritis.org/about-arthritis/types/osteoathritis/treatment.php. 2018.

Belagaje, Sudhir and Tye Ouzounian. Tarsometatarsal Joint Arthritis. June 2015. ONLINE:http://www.aofas.org/PRC/conditions/Pages/Conditions/Tarsometatarsal-Joint-Arthritis.aspx. October 2018.

Fong-Ha, Jennifer and Nancy Longnecker. "Doctor-Patient Communication: A Review." The Ochsner Journal (2010): 10(1): 38-43.

Georges Y, El-Khoury. "Practical Radiography: Principles and Applications." American Journal of Roentgenology (2006): 187(4): W440-W440. https://doi.org/10.2214/AJR.06.5070.

Hayashi, D., F.W. Roemer and A. Guermazi. "Imaging for Osteoarthritis." Annals of Physical and Rehabilitation Medicine (2016): 59(3): 161-169. https://doi.org/10.1016/j.rehab.2015.12.003.

"Medical X-ray Imaging." 29 August 2018. FDA: U.S. FOOD & DRUG ADMINISTRATION. ONLINE: https://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/default.htm. October 2018.

Mehta, Kishor. "Radiation: Basic Principles." Journal of Vascular Surgery

(2005): 42(6): 1237-1238. https://doi.org/10.1016/j.jvs.2005.08.022.