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Kyle FeldmanModerator
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 FeldmanModeratorGood 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 FeldmanModeratorYes
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 validityKyle FeldmanModeratorTaylor
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 FeldmanModeratorGreat 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 FeldmanModeratorDavid, 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 FeldmanModeratorSarah, 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 FeldmanModeratorSarah, 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 FeldmanModeratorGreat 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!
Kyle FeldmanModeratorSarah
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.
Kyle FeldmanModeratorSarah
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.
Kyle FeldmanModeratorDavid- 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 herKyle FeldmanModeratorGreat 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/foreheadKyle FeldmanModeratorGreat 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/foreheadKyle FeldmanModeratorGreat 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?
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