Kyle Feldman

Forum Replies Created

Viewing 15 posts - 31 through 45 (of 137 total)
  • Author
    Posts
  • in reply to: February – Wrist #9483
    Kyle Feldman
    Moderator

    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.)

    in reply to: February – Wrist #9413
    Kyle Feldman
    Moderator

    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?

    in reply to: January – Post Op #9368
    Kyle Feldman
    Moderator

    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

    in reply to: Being a good Mentee #9352
    Kyle Feldman
    Moderator

    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!

    in reply to: August- Imaging #9214
    Kyle Feldman
    Moderator

    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?

    in reply to: July- Pharmacology #9199
    Kyle Feldman
    Moderator

    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.

    in reply to: July- Pharmacology #9192
    Kyle Feldman
    Moderator

    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?

    in reply to: July- Pharmacology #9191
    Kyle Feldman
    Moderator

    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?

    in reply to: June- TMJ #9190
    Kyle Feldman
    Moderator

    Great points both of you

    so with this case, and with most cases, it is not 100% myo or artho.

    Her driver based on the treatment plan was myogenic but once we hit a plateau, the joint treatment and motor control training allowed for more progress.

    The key points that Laura is trying to present is that we NEED to be thinking pain drivers and differentials instead of just treating impairments!

    in reply to: June Journal Club #9180
    Kyle Feldman
    Moderator

    Sarah

    Thank you for your research on this case.
    I may not be able to make the call so I wanted to bring up these points for you to discuss on the call.

    Looking further at this study, it shows the mobs were performed after ultrasound.
    Did you perform the ultrasound on this patient (I haven’t seen a machine in 5 plus years so I am unsure how to turn one on)?

    Also, mobs were written at a certain MHz. Are you familiar with how to create the temp?

    Lastly, how long do you usually performs mobs on patients? I rarely see people spend 15 min straight doing mobs so would love to see how well this played out clinically.

    in reply to: June Journal Club #9179
    Kyle Feldman
    Moderator

    Sarah

    Thank you for your research on this case.
    I may not be able to make the call so I wanted to bring up these points for you to discuss on the call.

    Looking further at this study, it shows the mobs were performed after ultrasound.
    Did you perform the ultrasound on this patient (I haven’t seen a machine in 5 plus years so I am unsure how to turn one on)?

    Also, mobs were written at a certain MHz. Are you familiar with how to create the temp?

    Lastly, how long do you usually performs mobs on patients? I rarely see people spend 15 min straight doing mobs so would love to see how well this played out clinically.

    in reply to: June- TMJ #9175
    Kyle Feldman
    Moderator

    David- great points. we do not have to condone these types of additions that could lead to other issues.
    But I recently had a patient using medical marijuana and reported 80% improved symptoms. I did not say that was the answer, but I also did not say stop either.

    Yes, good idea of chewing
    that made a big difference for her

    in reply to: June- TMJ #9173
    Kyle Feldman
    Moderator

    Great idea!
    Yes, looking at the headaches more may find the myofascial driver for the jaw and may treat both!!

    She has base of the skull and a headache in the shape of a crown around her head
    The headache also goes into her temples/forehead

    in reply to: June- TMJ #9172
    Kyle Feldman
    Moderator

    Great idea!
    Yes, looking at the headaches more may find the myofascial driver for the jaw and may treat both!!

    She has base of the skull and a headache in the shape of a crown around her head
    The headache also goes into her temples/forehead

    in reply to: June- TMJ #9169
    Kyle Feldman
    Moderator

    Great questions David

    i think they are very valid and great to ask. You are placing great value in the psychosocial component of care and that is important here.

    Q1- if she said she just deals with the stress and has a glass of wine at nigh to unwind, what would you do?
    If she has no interest in adding a councilor or psych to her care, what would you do?

    Q2- She stated she is not sure. What homework would you give her to figure this out? Do you want her to think about it? Change things?

Viewing 15 posts - 31 through 45 (of 137 total)