Monday Memo 5/30/2017

The Monday Memo

May 30, 2017                                                                           PITT DPT STUDENTS

Welcome to Graduate School

 

The new class of future physical therapists will arrive at Bridgeside Point 1 this Friday for the very first time as Pitt DPT students. Looking back on my own orientation session nearly one year ago, I remember how excited I was to start my own journey, especially at a university as highly regarded as Pittsburgh. I had spent the past 4 years preparing for school: Working stints as a rehab aide, a strength coach, a personal trainer, and volunteering weekly at a therapeutic riding center. These experiences were instrumental in creating the student I am today.

 

However, with personal experience comes bias. This is even more true while you’re developing as an individual, a professional, and a clinician. Early on in your career, you have a very limited sample size to work with which means every experience holds a greater degree of influence over your perspectives, thoughts, and beliefs. As you begin your educational journey as an SPT, these beliefs will shape the way you view your classes, the experiences you have in clinic, and the research you perform in an effort to improve as a clinician.

 

It’s vitally important to maintain perspective, understand that the science and research is ever evolving, and nobody, including yourself, has all the answers. That being said, with any profession or skill there is a major theme that you must follow to reach the highest level of achievement: Keep an open mind and master the basics. “But the basics are boring, they’re dry”. It may take memorization and repetition day in and day out, but in the end this is where the master clinicians are made.

 

Keep this in mind over your next three years in Pittsburgh. Check your bias at the door when you walk into your first Anatomy class and start fresh. Relearn muscular origins, insertions, and actions. Keep an open mind to new ideas, new treatment methods, and continuously challenge your pre-existing beliefs. Pittsburgh will arm you with the tools to critically appraise EVERYTHING in the field of physical rehabilitation and determine the application to clinical practice. It’s up to you whether or not you want to use them. You’ll likely be a much more effective therapist if you do.

 

 

  • Charles Badawy, SPT, CSCS, USAW,

            Pitt DPT Class of 2019

May 30, 2017 |

Monday Memo 5/22/17

The Monday Memo

May 22, 2017                                                                           PITT DPT STUDENTS

Below is a hypothetical case study: The patient is representative of an impairment/functional deficit that is common in an outpatient physical therapy clinic. Leave a comment with the next steps that you would take if you were the primary clinician: Would you continue with the physical exam? Redirect your focus? Do you feel comfortable prescribing treatment from the given information? What other questions might you ask this patient? Is this a situation where referral may be needed? Why or why not?

 

Patient: 26 y.o Female Graduate Student

Chief Complaint:

  • Right shoulder pain with elevation affecting the ability to perform overhead activities and reach across to grab her seatbelt.

Onset:

  • Over 1 month ago — Occurred while performing dumbbell presses in a strength training group class. Immediate limitations included putting on a shirt and reaching across her body. Pain at the AC joint area.
  • Seemed to get better on its own over the next week or two… Then got worse after a poor night’s sleep. This worsening presented as more of a “constant” pain and stiffness with the patient feeling as though she needed to pop it back into place. Reports “cracking” with movement.
  • Seemed to get better again with time, but 2 days ago the patient was leaning on her elbows and pain flared back up after standing back up and unweighting the shoulder. New onset of pain is in a different place: More lateral to the AC Joint. Pain has decreased over the past 48 hours.
  • Worst: 5-7/10 , Best: 1/10

PMHx:

  • No prior history of shoulder injuries besides bilateral broken clavicles at a young age.
  • Pt has been dealing with headaches since teenage years. Two main types: First is typical with a cervicogenic left-sided “Ram’s Horn” presentation and also has referral to the supraorbital area over the R. eye. She also complains of tension-type headaches that she correlates with dehydration, stress, and posture. Reports that the tension-type headaches are helped with postural exercises (chin tucks).

Exam:

  • Patient appears to be in good health. Slender frame with average or slightly below average muscle mass. Slight forward head posture. Depressed R shoulder relative to L.
  • Full ROM with slight pain at end-range FLEX/ABD; 4/5 on MMT with most movements, but painful with resisted FLEX/ABD/ER.
  • Abnormal scapular mechanics noted with ABD. R side seems to get hung up, especially on descent. Flexion mechanics appear normal, but a “click” or “pop” is felt and heard with both movements on elevation and descent.
  • Special Tests:
    • No signs of instability or apprehension with testing.
    • Clicking felt with Load and Shift to assess anterior capsule/labrum
    • (+) Neers, (+) Jerk for anterior pain, (+) Crank w/ clicking, (+) Hawkins Kennedy
    • (-) RTC cluster, (-) Sulcus Sign, (-) Biceps load test

May 22, 2017 |