But to begin to get a better understanding is it always helps to begin things with looking at a case. I always find that when I'm teaching a section that it's helpful to begin a case that's relevant for everyone that's involved. And I try to take a case from that area. So I present something that someone would normally even see in the office, and having years in the office and looking at it, I had a kind of a model case. In this case, it was a 34-year-old male, had no significant past medical history, had seen the office from an urgent care visit a few weeks ago. They were playing in an amateur basketball league where he fell on his left side, hitting his shoulder and his upper back. He's evaluated after his fall in nearby urgent care where x-rays were negative, pain in his upper back, and lower back still persists, but his primary complaint is discomfort in his left upper extremity, which was tingling his left arm whenever he reaches back with his left arm. He said he has a bump at the base of his neck that is tender. He denies any fever chills, bowel or bladder changes, weakness, or numbness at rest. On his exam, his vitals are stable. Neurologic exam is uneventful, but we see some changes on his structural exam. And it decreased pulse, radial pulse, and tingling in his left hand when his arm was brought back while he's taking a deep breath. This is present when the patient turns and holds his head in both, to the left and to the right. The trapezius muscle is tender bilaterally, with significant discomfort to palpation over the head of the first rib on the left. Patient's then examined at supine position, and there's less motion compressing the left rib superiorly, more motion and gentle compression of the first rib, you know, on the right just below the cavicle. There's tenderness or promise to the left fifth thoracic transverse process. Lungs are secure. Oscillation of heart is regular rate and rhythm. So as I mentioned, we bring this in a case. So usually I bring that out, I'll go through it with the audience, but there's key things I have. So in this instance, when I'm presenting a topic area, what I like to do is I present a case to highlight what someone's going to do in that area that I'm trying to teach. So with this one, I want to get a patient who wasn't in a complex situation. Because especially if you're presenting a technique to novice learners, and you have a whole series of red flags where they have, you know, terrible radiculopathy or doing a consultant, and it's not very helpful, and you want to create a scenario where someone can be, you know, evaluated and treated by the clinician that you're presenting it to. So the idea here was showing a relatively healthy person. So they would have low risk for doing it themselves. We put things in the history that said, hey, look, there's no major problems, no major red flags in going through it, but they had some persistent discomfort. So that meant that he tried some conservative therapy or didn't do much, and things hadn't got back. The kind of giveaway here, we're going to go through this today, is he said when he reached back, you know, his left arm, he noticed he had this, you know, discomfort, you know, when he would have some tingling in his left arm whenever he reached back. So they kind of did, the patient was kind of doing an absence maneuver themself. So on the back of his head seeing that, he sees a bump at the base of his neck that's tender. You know, patients ascribe things, so that means there's some structural change there themselves. But we also, x-rays are there, so we know that there's no other fracture. The decision to look at that fever, chills, bowel, bladder change, again, it was looking at red flags. There's not a major problem. It's not radiculopathy. It's not cancer, because you look at those things. RIFT, radiculopathy, infection, fracture, tumor. If you don't have those pieces, then you move into more of a structural, mechanical, musculoskeletal problem. You know, again, the vital stable. There's not fever. There's not infection. Neurologic exam. So it's important. They don't have any deficit. So that way, the person feels comfortable. Now, on the structural exam, when you give, you're setting themselves up here. So what we described was honestly doing an absence maneuver in the beginning of how they were doing that. And we'll go through that today. And looked at some key muscles, and that's whole region, the cervical thoracic. So trapezius is a major muscle we're going to go through to get the person thinking about themself. And then talk about how there's motion in the cervical thoracic junction that seems to be, notice some changes with that. And again, mention lungs are clear, heart's regular. And that's brought in, again, to show that otherwise, this patient is not having other major problems with that. And then usually, I'll bring out this. You know, what is the diagnosis? What assessment tests are needed for accurate diagnosis? What maneuver treatment would be indicated? Now, these are prompts for people to think. So I'll put those things out. So the idea is so they can think through things. So when you have your learners, put a few prompts in the beginning. So they begin to think about things. So at least that makes sense to them. And then the goal of the whole lecture is the old thing is adage is, you know, tell them what you're going to tell them, tell them, and tell them what you told them. So in the beginning, now we're telling them, but also I'm thinking ahead of what things that they can do with that.

medical education

case study

shoulder injury

musculoskeletal issues

interactive learning