Episode 26- LISTEN! Let’s test your LISTENING and EVALUATION skills!

Let’s have some fun today:)

In Podcast Episode 26 called: LISTEN! Let’s test your LISTENING and EVALUATION skills, I will see how sharp your listening skills are.

  1. Start by asking questions that rule out complications.
  2. Don’t ask too many open ended questions.
  3. Be diligent at “teasing” out certain diagnoses.

 

Today’s patient presentation:

  1. 14 y/o male with c/o left shoulder weakness
  2. Reports having “possibly” dislocated shoulder at age 11.
  3. X-rays were negative. No follow up until 3 years later
  4. PE teacher noticed awkward left shoulder mov’t with weight training in PE class. Esp. bench press and military press.
  5. c/o difficulty controlling basketball with left handed dribbling
  6. PE teacher refer student to school AT. AT notices a definite “Clunk” in the “pitcher’s position”
  7. Pt. denies any significant pain and denies paresthesias.

Observation:

  1. No atrophy
  2. AROM slightly less controlled into flexion and abduction. Difficulty with active IR. (90% of NL flex and ABD)
  3. PROM-WNL without pain
  4. Scapular motion-WNL
  5. Neuro exam- DTR’s, sensation, distal MMT is WNL’s.
  6. MMT of the shoulder: Flex. 4-4+/5 ,  ABD. 4/5,  ER 4+/5,  IR 3/5 (painless weakness)

Special tests:

  1. C-spine compression test: NEG
  2. Spurling’s test: NEG
  3. Liftoff test: POS
  4. Bear hug and Belly Press tests: POS
  5. O’Brien test: POS
  6. Horizontal ADD test: NEG
  7. Clunk test: POS
  8. Apprehension sign: NEG
  9. Relocation test: NEG
  10. Empty can test: NEG
  11. Posterior apprehension sign: NEG

Do you know what the answer is? Do you have more questions to ask? Go HERE to leave an answer or ask a question.

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2 Comments

  1. Christine Doody on 04/10/2018 at 9:32 PM

    Paul, I really enjoyed this podcast. Although I enjoy your stuff overall, I particularly like the parts that require some decision making. I haven’t listened to the end yet, but from the information you gave, it seems like he has symptoms of a SLAP tear and subscapularis tear. I’ll listen to the end, and hopefully if you know for sure what the outcome is you will share (if you don’t at the end of the podcast).

    • Paul Marquis on 04/14/2018 at 9:11 PM

      Hi Christine! You are correct! We all suspect the SLAP. What is very interesting is that we received his xrays yesterday and it looks like he avulsed his lesser tubercle off of the humerus. Very difficult to manage since it is 3 years old. This kid should have been referred to ortho right away.
      Best regards,
      Paul
      FYI- This is a new product I developed and am manufacturing in PI. Blue Jays are using these right now and I’ve sent one to the Celtics and Atlanta Braves. Feel free to spread the word!! Great for PT clinics, fitness centers and athletic training rooms.
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