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Should be on your differential.
Good recent review here.
Please think neural entrapment in the region.
Various nerves – illioinginual, obturator, femoral, pudendal, genitofemoral.How would you asses these specific nerves?
Would you refer, and to who?Primary Hypothesis: Secondary Impingement w Scap dysfunction
Special Tests: Sulcus neg. Load and shift neg. Neers neg. Hawkins Kennedy neg. Biceps Load II neg. Apprehension neg.
Justin please discuss your asterisk signs: There is not very clear reasoning.
If this is your primary hypothesis – what findings lead you to that hypothesis?
Please be more specific with scapular findings.
Tyler – Think “Functional Patient Centered Goals” when multiple body regions. You can kill many birds with one stone, as you have them tell you functional versus pain goals; and you design functional exercise prescriptive exercises based on those functional goals versus chasing pain complaints.
Always challenging, but take a step back and keep it simple – let the patient guide your treatment.
Great job
What a great learning case – continue to take aspects of this presentation and your treatment successes and build upon. That communication and treatment decision making involving the patient preferences/priorities are ART of what we do.
See ya Saturday.
Tough case for MOI.
Question: Any anti-inflammatories used?
Seems as though possible cause of exceeding muscle/tissue capacity during his weekend physical activity (typical of “weekend warrior” type presentation.). Likely muscular and chemical response s/p that increased activity, with resulting “dysfunction” of cervical area joints. This chemical response likely affecting nerves at this time.I’d wonder if some anti-inflammatories and easy movement would simmer down the symptoms.
*hope I’m using this forum discussion correctly in content and purpose.- see y’all this weekend*
-Matt DHi Katie –
Have you considered intermittent claudication? If you haven’t already, you may want to check pedal pulses. Here is a link to an article which may be helpful: http://www.aafp.org/afp/2006/0601/p1971.html
If you are interested or think this may be a viable dx, I would be happy to provide articles regarding walking programs and studies once I get back to my office.This is a tool that can be helpful when trying to determine specific functional goals. It is based on fear of doing activities but may be helpful with your patient.
With a 25 yr history, and complaints of everything (GI/nausea/possible DVT/swelling), You can easily chase random symptoms every visit until one of you gets frustrated.
I would get him to commit to functional goals, and work toward those functional functional goals by addressing impairments toward those functional goals. Did I mention functional goals?
Pain of 25 years that is unrelieved by Neurotin and Narcotics probably won’t respond to some magical PT experience/treatment.
? other thoughts ?
What cues can we give these patients that won’t just screw them up? (Looking for some input from Eric Magrum on this one). Do we tell them to try to stay on the outside part of the heel, or maybe “get back to the outside of the foot quicker”?
Increased cadence cues to get people off the ground quicker – less time to pronate through stance when using elastic recoil to spring off the ground with a faster cadence (10% increase ideally).
External cuing with metronome or music best for motor learning; compared to an internal cue like, don’t hit on the outside of your foot.
The difficulties are with older folks (less elastic tendons) to be able to get off the ground quicker; and shifting stress to the Gastroc/Achilles obviously can be problematic with tendinopathy. My experience is that with achilles tendinopathy is that if there is a larger calcaneal EVR at terminal stance (pronation later int stance) they do great with increased cadence cues. May need to be graduated in more slowly.
Also think drills for running – progressively stress the tissues more efficiently.
Thoughts???
Thanks for posting Erik
My experiences with patients is variable; as the techniques of preparation/injection are variable.
I’ve had patients with success at the patellar, hamstring, lateral elbow, Achilles – but as many failures as successes.
My recommendation to patients when they ask; is to be an educated consumer; understanding that the evidence is conflicting.
There are a handful of practitioners in our area injecting. So I’d encourage you to contact and query those practitioners on injection procedures, as this article had some conclusion on the best concentration and injection method (which is what is needed for outcomes to be more consistently measured).
It is out of pocket typically – so patients are paying $300-$500 per injection.
Biologics is the future of orthopedics – but the specificity for concentration of components and specific growth factors is not there yet.
But stay educated and up to date, so you can counsel your patients accurately.
Have a great weekend all.