Exposure to the field of Physical Medicine and Rehabilitation (PM&R) is limited in the curricula of many medical schools. As a result, many students lack awareness of the field and may therefore ultimately choose different careers. A medical student PM&R career fair was held on October 13th, 2015 at the University of Pittsburgh, and several local medical schools were invited to participate. Seven stations were deployed to highlight various aspects of PM&R careers. A total of 57 medical students attended, representing five different campuses across three states, with 29 of the reported medical students still within their first or second year of medical education. Self-reported interest and understanding of PM&R significantly increased in those attending the fair compared to baseline, with nearly half requesting further opportunities for faculty mentorship. These results indicate that PM&R interest fairs may be a means to further student understanding and awareness of PM&R while providing an opportunity to become more involved in the field.
meniscus. Second meniscectomy of the lateral meniscus was then performed, followed by standard physical therapy and returned to sport 3 months after surgery. After a full season, athlete now presents with persistent, residual anterolateral knee pain, and intermittent effusion after trainings. PHYSICAL EXAMINATION: 1. Full ROM 2. Flow test: negative 3. Strength test: Flexion and extension 5/5 4. McMurray/Apley tests: negative. Thessaly test: positive. DIFFERENTIAL DIAGNOSIS: 1. Meniscal tear 2. Synovitis 3. Post-traumatic osteoarthritis TEST AND RESULTS: Right knee MRI: • Mild degenerative thinning of lateral tibiofemoral cartilage • Moderate joint swelling, compatible with a synovitis • Tibial plateau deep cartilage fissures and mild bone marrow edema, progression of chondropathy Knee kinesiography (3D knee dynamic functional gait assessment): • Stiff knee gait, a protective mechanism characterized by the knee locked in extension during loading and stance demonstrating loading /absorption dysfunction • Static valgus alignment increased dynamically during loading phase and maintained during stance phase of gait demonstrating increased load on lateral compartment FINAL WORKING DIAGNOSIS: 1. Mild osteoarthritis of the lateral compartment 2. Mild synovitis TREATMENT AND OUTCOMES: 1. Athlete was educated on his mechanical dysfunctions and given home-based targeted neuromuscular gait re-training exercises to: • Improve knee flexion and absorption • Address static and dynamic frontal plane valgus instabilities 2. RICE + Monovisc viscosupplementation and 2 corticosteroid injections At 1-year follow-up, athlete maintains play at professional level with minimal pain and effusion. All KOOS subscales significantly improved. Knee kinesiography exam reveals improved dynamic knee function: • Improved absorption strategy with more flexion movement during loading • Improved dynamic frontal plane alignment during gait.
BackgroundElbow conditions and pathology are commonly seen in the outpatient clinic. Telephone and video visits can allow for expeditious assessment of elbow complaints, without the added challenges of commuting for a clinic-based evaluation. In the setting of a pandemic, the benefits of telemedicine are apparent, but the time and effort saved from being able to remotely evaluate musculoskeletal conditions are also useful in a nonpandemic situation. In this modern era of telemedicine, protocols need to be developed to provide guidance for a remote elbow evaluation. As with all musculoskeletal conditions, the history about the elbow complaint allows the clinician to develop a differential diagnosis, which is either supported or refuted based on physical examination and diagnostic studies. Appropriate questions asked over a telephone call can provide answers that lead the clinician to a specific diagnosis and treatment plan. Furthermore, responses to these same questions can be further supported by a video assessment of the affected elbow, which may provide additional evidence to support a diagnosis and plan of care. AimsTo outline possible questions, responses, and video examination techniques to aid the clinician in elbow examinations conducted via telemedicine. MethodsWe have created a pathway for step-by-step evaluation to help physicians direct their patients through the typical elements of a thorough elbow examination via telehealth. ResultsWe have created tables of questions, answers, and instructions to help guide the physician through different aspects of a telehealth elbow examination. We have also included a glossary of descriptive images that demonstrate each maneuver. ConclusionThis article provides a structured guide to efficiently extracting clinically relevant information during telemedicine examinations of the elbow.
Aquatic athletes not only face common headache etiologies similar to the general population and land-based athletes but also experience their own unique pathology. Posture, aquatic pressure, equipment, and even marine animals pose as unique causes to head pain in the aquatic athlete. Common head pain pathologies seen in the aquatic athlete include tension-type headaches, migraines, cluster headaches, and compressive headaches, including supraorbital neuralgia. Creating a thorough but focused differential diagnosis for head pain in the aquatic athlete can be a difficult and overwhelming task for some. We review both the common and not-so-common etiologies of head pain in the aquatic athlete and suggest a simple framework for assessment and treatment to diagnose and treat head pain in this specific population.
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Case:A 60-year-old woman presented with knee instability and pain that started approximately 13 years after a posterior stabilized total knee arthroplasty. Physical examination revealed significant posterior laxity. Bedside ultrasound (US) documented a free-floating, hyperechoic linear artifact within the posterior knee joint capsule. Revision with liner of increased thickness alleviated presenting symptoms.Conclusion:Tibial postfractures often present with instability and pain. Diagnosis of a tibial postfracture can be based on clinical examination; other diagnostics commonly used include arthroscopy or computed tomography/magnetic resonance imaging. US by a qualified sonographer is a potential diagnostic route that should be explored more rigorously.
HISTORY: 18 year old male presented with pain in his bilateral feet, ankles, and lower legs that began 8 months ago after playing basketball. He dove for the basketball and landed on his right hip and his teammate landed on top of him. The following day, he was playing in a basketball game and he landed on his right hip again after getting a rebound. Ever since the second fall, he has had pain in his BLE that starts in his feet (dorsal and plantar aspects) and radiates proximally to his posterior ankles and then to his calves. He states that the pain typically stops at the mid-calf region. The pain consistently begins 5 minutes into jogging and running or 15 minutes after playing basketball. He describes the sensation as burning and cramping. He states that he also has low back pain but this pain does not radiate down his legs. He denies fevers, chills, bowel and bladder issues, night pain, and saddle anesthesia. PHYSICAL EXAMINATION OF BILATERAL LOWER EXTREMITIES:No erythema, edema, or ecchymosis. Non-tender to palpation over bilateral calves, medial and lateral malleoli, anterior ankle, fibular head, and ankle syndesmosis. Full ROM in the BLE. Hip Flexion 5/5, Knee Flexion 5/5, Knee Extension 5/5, Dorsiflexion 5/5, EHL 5/5, Plantarflexion 5/5. Negative Straight Leg Raise test bilaterally, Negative FABER and FADIR tests, Negative Syndesmosis Squeeze and Thompson Tests DIFFERENTIAL DIAGNOSIS:1. Lumbar Radiculopathy 2. Chronic Exertional Compartment Syndrome 3. Peripheral Neuropathy TEST AND RESULTS: Bilateral Hip X-Rays were unremarkable. MRI Lumbar Spine demonstrated Spondylosis at L5-S1 but no evidence of nerve root impingement, neuroforaminal stenosis, or spinal canal stenosis. BLE compartment testing demonstrated compartment pressure of at least 25 mm Hg at baseline in all 4 compartments bilaterally and an increased in compartment pressure to over 30 mmHg 1 minute after physical activity in all 4 compartments bilaterally except for the Left Deep Posterior Compartment. FINAL WORKING DIAGNOSIS: Chronic Exertional Compartment Syndrome TREATMENT AND OUTCOMES: Patient has been referred to an Orthopedic Surgeon to discuss possible surgical interventions including fasciotomy. He is also considering non-operative interventions which consist of working with a physical therapist to revise his running mechanics.
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