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
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.
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.
Catch you guys on the flip side,