[Kyle Feldman]

Great points Ian

Adding family is key….. its also important how you do it. You want to have the athlete open up, not close up more.
Think about your strategy. what would the conversation look like?

Another question:
Would you approach this differently from a 24 year old patient?

[Kyle Feldman]

Great case Laura

Think of yourself in high school and college. What would you think of if a teammate did this?

[Kyle Feldman]

Great tests:
they all come back very off so you are thinking next steps.

Where would you refer this patient and how would you communicate to the referring provider?

A second question to understand your first visit process….

What is your method for reviewing relevant medications during evaluation and treatments?

[Kyle Feldman]

Little late, but great reflection! lol

If you do not see these patho’s its easy to forget. Always good to do these things to keep your mind fresh.

In clinic you may not see a pathology for a year. When that happens you need to go back and review your notes. Always relearning

[Kyle Feldman]

ask which type, sometimes its the right idea, just the wrong one

[Kyle Feldman]

Great differentials and questions everyone

As you ask the questions and change your differentials, make sure that you are changing the order of the ranking for your hypothesis.
We see residents asking the right questions but the thinking of diagnosis doesn’t seem to change.

More questions:
With every patient, we need to consider contributions from any psychological or social aspects that might impact our care or response to treatment. Starting with a yellow flag screening tool is an excellent place to start evaluating these components. What screening tools could you utilize with this patient?

If there was a higher psychological component in her case, how would your plan of care change?

[Kyle Feldman]

Great case Emily. It is a tough treatment.

With this patient, I would consider a 1st CMC brace. They can be valuable like a foot orthotic as a way to calm down symptoms due to so much use.

Amazon has many options and its often trial an error, but if they help, it can calm down symptoms enough to help make the exercises better.

Did your patient try a brace yet?

https://www.google.com/search?q=1st+cmc+braces&rlz=1C5CHFA_enUS832US832&sxsrf=AJOqlzUN7dbJytXhg8gYTHdOtBySYxaKHA:1678901338023&source=lnms&tbm=shop&sa=X&ved=2ahUKEwi9j_buut79AhWsEFkFHfhpAn8Q0pQJegQIBRAE&biw=1177&bih=597&dpr=1

[Kyle Feldman]

Great job residents

Ended up sending him for imaging.
He had a confirmed TFCC tear
Ortho did an injection and we continued PT.

He was able to return to golf in about 8 weeks (sadly he had a flare up on a miss hit and had some regression a few weeks in.)

[Kyle Feldman]

Good differentials

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

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

[Kyle Feldman]

Yes

thats exactly the goal- to go off them as guidelines and understand tissue healing

I am glad you are getting that. Sadly some PTs 10 years out do not understand that.

Emily- great point about the research. Some MDs just make them without much science behind them.
We need to use research and evidence based protocols if we are going to use them. Maybe use the surgeons as a guide but make sure to compare it with one that has strong validity

[Kyle Feldman]

Taylor

Great post.

So glad to see your still thinking about VOMPTI

As a graduate myself, I felt that mentorship was the best aspect as well.

I want to echo what Taylor said and emphasize that mentor time is great, but the most impactful time is spent before the session and after the session. This is where the growth happens.

Take the time to do this, your personal and professional life will thank you down the road!

[Kyle Feldman]

Great differentials!

What would you tell her she can do?
I ask because we see people say I will refer, but what does the patient do until that time?
If you say take it easy…. what does that mean, do you put her in a walking boot, crutches?

how do you best set this patient up for success? Do you decide based on your worst case differential, or are you just punting because you are not sure?

[Kyle Feldman]

David, great job of the differential thinking!
This is exactly what we want you doing at a resident level clinician.

Looking at all possible structures involved and ruling out before deciding what to do.
Treating local tissue or at the spine for nerve issues is something we can do to try to make change.
Adding the referral for the medication is valuable.

looking at each structure and determining “what % of the pie” each piece may be for the puzzle is key.

Medication may be a large piece of this case but most likely nothing is in complete isolation.

[Kyle Feldman]

Sarah, I wanted to make sure you read that he was coming in for his 6th session and not his eval.
He has been seen for 5 sessions so far with progress in symptoms.

However, 2 days before this session he noted the changes in symptoms as a regression.

What are your differentials for the patient for changes in symptoms?
How would you word the subjective questions to help differentiate the hypothesis?
What are the key tests you need to do today?

[Kyle Feldman]

Sarah, I wanted to make sure you read that he was coming in for his 6th session and not his eval.
He has been seen for 5 sessions so far with progress in symptoms.

However, 2 days before this session he noted the changes in symptoms as a regression.

What are your differentials for the patient for changes in symptoms?
How would you word the subjective questions to help differentiate the hypothesis?
What are the key tests you need to do today?

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