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TOS = description of sxs in a region that is dynamic (rib cage/breathing).
Vascular TOS (< 5%)- should be a red flag, and think anomalies versus Neurogenic TOS (> 90%) which you need to think of structures in the TOS region.
What are those structures to specifically asses?
What objective measures/”special tests” stress those specific tissues; and how can that information help you be more specific to guide treatment?
Please continue this discussion – always a challenging patient presentation with clinical reasoning/asses-re asses to guide specific treatment decision making.
Here are some of my thoughts/questions:
– What about training history/errors prior to injury/beginning of season
– Specifics of her orthotics – do they accomplish what you would think they should
– what does imaging (-) mean – what imaging, and what results – can guide treatment decision making or mean nothing
– Please discuss search strategy/results, and how came to choose this specific article
– MTSS is a continuum from soft tissue to bone pathology – where do you feel she is on this spectrum?
– ? walking, and running gait mechanics
– what is the medial gutter in this case (knee joint assesed arthroscopically)Looking forward to the discussion
Kevin Wilke was and always has been big on perturbation training for all injuries – especially ACL (unexpected perturbation training especially).
Here’s a good resource from him.
Page 4 starts to talk about Kinesiophobia and return to sport, and proceeds into perturbation training.
Sorry videos not included.
Where do biopsychosocial factors fit in here; especially with LSI > 90%.
How do you address?
Lots of evidence here to be aware of and clinically asses/address.
– Physiother Theory Pract. 2017 Feb;33(2):103-114.
Factors informing fear of reinjury after anterior cruciate ligament reconstruction.
Ross CA1, Clifford A2, Louw QA.– Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors.
Burland JP, Toonstra J, Werner JL, Mattacola CG, Howell DM, Howard JS.
J Athl Train. 2018– The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction.
Ardern CL, Österberg A, Tagesson S, Gauffin H, Webster KE, Kvist J.
Br J Sports Med. 2014 Dec;48(22):1613-9From the Non Arthritic Hip CPG – newer updated articles out there as well.
Maeyama A, Naito M, Moriyama S, Yoshimura I. Periacetabular
osteotomy reduces the dynamic instability of dysplastic
hips. J Bone Joint Surg Br. 2009;91:1438-1442. http://dx.doi.
org/10.1302/0301-620X.91B11.21796Another more recent article with author to know (Clohisy JC)
Intermediate-Term Hip Survivorship and Patient-Reported Outcomes of Periacetabular Osteotomy: The Washington University Experience.
Wells J, Schoenecker P, Duncan S, Goss CW, Thomason K, Clohisy JC.
J Bone Joint Surg Am. 2018 Feb 7;100(3):218-225.Alright so since no one is very helpful for Sarah and this case.
Big “gap in Knowledge” here.
What a perfect opportunity to work on some “Clinical Questions/Searching the Evidence” to answer patient specific questions.
So before I jump in in my thoughts, and steer this discussion.
I would like each resident to come up with a PICO question related to this case; search the evidence, review a related article, and post clinical thoughts/applicability.