Cases in Point

Hello, and welcome back to another installment of Dex's blog adventures. I'd first like to thank everyone for the positive response to last week's case report. I'll do my best to put together a few more cases to share in the weeks to come.

Cases really are the best way to train your mind to think critically and to pick up on subtle clues to reach a diagnosis. If you like radiology and case reports, as I do, try the American College of Radiology website's Case In Point. Each day the ACR posts a new case with images to subsequent. These cases are pretty challenging at times, as the ACR targets their cases towards radiologists, but they are at the very least a decent learning tool. 

Perfecting the Diagnosis

So today I'd like to share with everyone yet another semi-pitfall I had with a patient here in clinic. I've been treating this individual twice a week for four weeks for lower neck/upper shoulder pain. The history and exam led me to a diagnosis of cervical sign facet syndrome with some upper trapezius muscle, levator scapulae muscle and pec minor muscles hypertonicity. I treated the patient as I would any patient with these diagnoses, which you will see a lot, with adjustment of the cervical and thoracic spine, myofascial work, and postural correction. Not to toot my own horn, but I've seen a lot of success with these treatments for these issues, but not with this patient.

The patient would find some mild relief from the treatment I was giving him, but no lasting gains. Therefore, I took a step back and did some research on something else that could be causing these signs and symptoms and found a paper on Levator Scapula Syndrome.

The paper describes the origin of some forms of shoulder pain to the Levator Scapula muscle and how to treat the issue. According to the paper, I had been treating the condition pretty right on, but it alluded to the fact that an over-facilitated infraspinatus muscle on the ipsilateral (same) side could contribute to a dysfunctional levator scapula. Duh, right? The very next patient visit, I stressed the infraspinatus by resisting external shoulder rotation, and boom, the symptoms were perfectly recreated. I reformed my treatment plan to include some myofascial release of the infraspinatus muscle and within two weeks, the patient was right as rain.

As physicians we won't always get the perfect diagnosis on the first go round. Even more important than getting the correct diagnosis the first time, is recognizing you hadn't and rectifying that. It's all about putting the patient first.

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Perfecting the Weekend

This weekend I took a break from putting patients first and enjoyed myself a bit. Friday, my pals and I were first in the VIP line (no big deal) for the Brews By the Bay craft beer and food tasting at the Florida Aquarium. Needless to say we had a great time. There were over 200 beer vendors and over 100 handing out food, all with the back drop of live music, shark tanks, sea turtles, and any other creature of the sea you could think of.

Then just for good measure I hit the Bucs game on Sunday. I helped my uncle out by taking his tickets off his hands in the 5th row on the 50-yard line while he was out of town. On top of that, my Florida State Seminoles and Tampa Bay Buccaneers put wins up on the board. Pretty darn good weekend.

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Catch you guys on the flip side,

Dex