[Kyle Feldman]

Great answers.
I was shocked and sent her to the ER.
After 3 hours, they cath-ed her and sent her home.
I could not believe it!!

I used a connection in NOVA and we got her seen in an ER there. She had an MRI performed and they found a mass in her sacrum. It was a spread of cancer

[Kyle Feldman]

Great reflection.
It can be complicated, you want to look at all options, read the patient, the family, and all aspects of what could be going on.

You are a huge person in this patients life during a very vulnerable phase

[Kyle Feldman]

Great differentials

It ended up being an inf ramus pubic ramus fracture!

[Kyle Feldman]

Very true and great points.

For him, it was a huge increase in pain and reduction in function.
Barely any desire to get out of a chair when walking in the neighborhood used to happen every day.
His wife was very concerned about this immediate change in status

Additional questions:

Where would you refer this patient and how would you communicate to the referring provider?
What is your method for reviewing relevant medications during evaluation and treatments?

[Kyle Feldman]

Great!

Based on the pharmacology, would you have asked about meds, would you have known the side effects of statins?

[Kyle Feldman]

your welcome! I love it as a quick test to add at the end of my exam

[Kyle Feldman]

Have you heard of the bite test?

another way to quickly look at myofascial vs joint!

[Kyle Feldman]

Great points Laura on headaches.

We cannot treat all of the headaches but we need to know what it is and where to refer. That is where the subjective exam comes into play.
For the ones we can treat, we need to have a good objective exam to find impairments.

What test can we do to help determine disc vs myofascial jaw pain? There is a special test that can help us think one ve the other

[Kyle Feldman]

Great differentials.

How about the yellow flags. How would you assess and monitor this aspect to her care?

Reading the article, you can see how much depression and anxiety plays into TMJ and headache cases.

[Kyle Feldman]

Great ideas!

It ended up being TFCC.
He had an MRI due to another injury 2 weeks later.
He had a local injection along with PT and was able to play in his last match of the season.

Please look and respond to the March post next

[Kyle Feldman]

Great
you have some different differentials

Next questions:

Can you highlight key clinical examination components that would help the best with narrowing down your differential diagnosis?

No imaging has been performed as of yet, so what would be important points to help decide whether to refer for an orthopedic exam and imaging?

[Kyle Feldman]

Sorry,
that was me, just signed in under my therapist!!

Great plans

Lets say this is a concussion with some WAD symptoms

How would you treat based on the research?

[Kyle Feldman]

Great ideas.

Day 1- a lot of the tests were positive due to high irritably and severity.

With positive cervical/thoracic as well as the vision/headaches/dizziness.

When it is so severe, what would you do first?

[Kyle Feldman]

So this lady was sent to the local ER and they sent her home with a cath.

I didnt like that so I sent her to a northern virginia ER. Images taken and they found that her cancer had metastasized to her sacrum.

She ended up going to Hopkins and having surgery.

This was a crazy case and luckily as a PT we kept pushing to find answers and not being satisfied that we did our job and moved on.

Keep critically reasoning and caring about your patients.

[Kyle Feldman]

Agreed!

Neuro was positive for reflexes, sensation in the groin region and hoffmans was positive

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