🤕🤦♂️Headache Thread🤦♀️🤕
I will try to cover common DDx in 1ry & 2ry Headache, Red Flag/screening Qs, resources/links etc
I may add to it over time so consider bookmarking / sharing if useful.
Aimed towards MSK clinicians, FCP/ACPs, Primary Care non-medics for now
So I have some exciting news I've been bursting to share!
30.4.22 Hannah and I eloped to Edinburgh after 9 years together we tied the knot. 🇫🇮🌸💍👩❤️👨
It was a perfect day, and this photo sums up the joy we experienced together. We can't wait for our honeymoon next weekend ✈️🇱🇰🇲🇻
Ok physiotwitter so why have I got a tenosynovitis/bursitis in my 3rd MCP.
Please advise if this looks like something different - had a course of ABx and Naproxen, awaiting bloods. Similar issue in knee few months back.
I asked
#ChatGPT
from
@OpenAI
to write a rap to aid cranial nerve recollection and tests. It's quite phenomenal what this software can do so quickly 🧵🖥️
Wore a mask for food shop today.
Did I feel like a prat? ☑️
Did I get lots of funny looks? ☑️
Was there many other shoppers wearing masks? 👎
Till worker: "whatever makes you feel safe"
My mask protects YOU, your mask protects ME.
#Masks4All
@trishgreenhalgh
I credit
@AdamMeakins
& his blog for the most accelerated development in my early career. Calling out quakery, critiquing evidence and modernising physiotherapy. Loved his course, even the neuromodulation (😬). He has personally been supportive to me.
#GoodlLuckMeaks
Have. Been. Saying. This. For. Ages.
Why are we McMurraying everyone!
'no longer recommended because of concerns that it exacerbates the injury & its low diagnostic accuracy.' (NICE CKS)
HT
@MRWPhysio
also via
@benedsmith
paper
Can anyone give an example of dermatome testing giving a useful bit of clinical information that wasn't provided through subjective and has changed management? I think some level of sensation testing is good but it's routinely done so badly I don't consider it reliable? Thoughts?
Ok, stupid question, been round in a loop on this one:
1) do people feel Frozen Shoulders follow distinct phases?
2) do people feel it is self limiting?
Questions previousy answered (or so I thought afted reading
@PainSci
doc
Anyone have any top tips for managing expectations. It would be lovely to feel interactions as a dance rather than a battle (all the time) and feeling like the "bad guy" for not immediately refering on for imaging/surgical opinion inappropriately. Not sure an easy fix.
*With full sharing consent*
75M Heavy Smoker.
3/52 Hx noticed atraumatic 8cmx6cm 'lump' appearance. No pain. Seems to self appear/reduce on certain movements. FAROM GHJ. CXR and recent bloods NAD. No apparent UL neurology. No bruising.
Next step / by who / how quick / why?
@DrJN_SportsMed
@suzy_speirs
Not from me Doc, sorry you feel that way / recent posts. I know I speak for many that your insight and time is extremely welcomed and valuable
"No appointments", "only telephone calls". I'm still amazed at people's beliefs and expectations from their GP and how far away it seems from my experience and reality. Our GP colleagues work SO hard and are still there for us, including F2F where appropriate
#TeamGP
Reflection of the week.
Told someone today with LBP they had "bags of potential" "their spine moves lovely" - first time anyone has ever said that to them.
We must do better to instil confidence and capacity in people.
A patient presents with weight gain, constipation, dry skin, brittle nails and fatigue. What’s the clinical sign & diagnosis?
@IhabFathiSulima
#medtwitter
Right then Twitter. Facilitating a Red Flags Study Day for OPD MSK clinician's with <1y experience generally. They will have a few hours of spinal and peripheral RF/masqueraders in advance.
Thoughts? Suggestions?
What do you wish you knew in more depth/breadth/faster?
Thanks to Jack's post it prompted me to give similar advice to this recently but didn't realise there was supporting images (this would have helped at the time) does anyone have any similar/suggestions of activity modification?
Took a break from logical fallacies for a while (got called out for using fallacy fallacy HA) but back on them again while trying to level up the reasoning/questioning/critiquing skills.
Below are some examples and link to
@AdamMeakins
series on insta too.
Looking for help to educate knee
#OA
patients? Check out this 12-min video from
@thorlenee
@CHESM
with help from
@LiamRobMac
& Joshua Simmich from UQ ........use it to start a conversation with patients about the best course of management
Had a fantastic "
@PeteOSullivanPT
moment" with a chap today. Dramatic reduction in distress, gaurding and positive outlook.
🔑Not damaged
🏋️Safe to move and lift (and proved it to himself through mvt experiments)
🧘♂️Relax and breathe
❌ Time of work
👏 SLOUCHING FEELS GOOD
Top "special"/orthopedic tests/clusters to rule in/out certain conditions.
That one uses clinically and can justify why with sens/spec/utility/explaination.
I'll start Cluster of Wainer.
Go....
Question, do you assess 'full neuro' (dermatomes, myotomes, reflexes, UMN signs) on nearly everyone with localised neck/back pain with no peripheral features (no radiating symptoms/paraesthesia/weakness)?
🏆ABSOLUTE GOLD 🏆
❌🤕 WEAR AND TEAR
✔️🦵BEND AND MEND
✔️💦 MOVE IT TO LUBE IT
✔️🧠 RETRAIN THE BRAIN - more you know, more you can grow
✔️🏃USE IT OR LOOSE IT (rest is rust!)
@noigroup
@DrJN_SportsMed
I found this helpful when thinking of DDx, initial Hx made me wonder dysplasia but as other posts have said perhaps a little older. Good ROM + Hx I might have thought atypical GTPS. Following for further detail
Great blog on CSI and the shoulder case study, patient centered care, limits in biomed approach, importance of language and goal focused structured rehabilitation.
via
@JaredPowell12
HT
@AndrewVCuff
Good news: cycled into work and feel great for it 🚲💪
Bad news: lost a bottle at 50kph down a hill and found out I'd left my trousers at home, soggy cycle leggings for the morning and borrowed some trousers from the lovely community nurse/OT for the PM 😳👖
When Orthopods say "you'll probably need the other *joint* doing at some point" is that one of those win-wins where if the patient doesn't- they are happy and got away with it and if they do you can say "told you" and gain trust!?
Looking forward to my first day in an Advanced Practice role within the existing Notts
@Connect_Health_
team, new challenges and experiences on the horizon.
Any reflections or tips from those with more skin in the game?
Long but facinating commentary on CES with key points regarding clinilinical signs vs symptoms, CES "early"/incomplete, MRI urgency+threshold, documentation, safetynetting, hospital guidelines and bladder scans.
Jarman v Brighton and Sussex University Hospitals NHS Trust [2021] EWHC 323 (QB) - new judgment on cauda equina - alleged delay in MRI and decompression surgery - C unsuccessful
MRI Result via local sarcoma unit Bilateral Elastofibroma Dorsi (benign lesions).
(With Pts consent)
Few suggestions of this DDx within the original comments, all's well that ends well.
*With full sharing consent*
75M Heavy Smoker.
3/52 Hx noticed atraumatic 8cmx6cm 'lump' appearance. No pain. Seems to self appear/reduce on certain movements. FAROM GHJ. CXR and recent bloods NAD. No apparent UL neurology. No bruising.
Next step / by who / how quick / why?
Thank you for the invite. Kids so well behaved.
Glad
@thecsp
#RehabMatters
video, clinic role play and profession clues & anatomy quiz was a hit!
Your students in nearly knew more anatomy than me as a junior!
Other physios interested ➡️
@InspiringTF
Favourite papers/resources/threads on communication?
Ping them my way please 🙏
E.g. rapport, open questions, MI, SDM, safetynetting, consultation skills, conflict management, ICE, goals etc.
Please tag where approp.
Have my own examples and plan but checking widely. ✅💭
" I would add that employees stay when
1) we create opportunities for them, and give them opportunities to grow
2) take risks for them
3) treat their problems as our own
4) stand up for them
5) treat them fairly
6) stay honest with them"
HT
@MRWPhysio
Great day exploring and discussing clinical reasoning. Some big take homes regarding governance/pathways/supervision, systems thinking, masqueraders and FCP ☕
@stevenawoor
@ClinicalMaze
💉🦴💪 Great case studies, reflections and pragmatic conversations.
**FAO Students and newer grads**
Wondering where to start with information overload?
Looking for short evidence based learning to focus your reading?
Wondering how you can demonstrate your learning and test yourself?
@clinicalphysio
1/2
Had a
@benedsmith
moment. 70y/o PFJ OA pain ⬇️ stairs and hills, gave up Morris dancing as thought 30y of it caused it and 'cant do the movement'. Asked her to show me and she did it pain free and realised she'd just been scared to try and considering returning to it! Result!
#louisgifford
blowing my mind again and confirming/challenging some bias RE placebo and the importance of pts beliefs/expectation and clinician interaction.... Whilst by the beach 🌴
I wonder if many other healthcare professions have to "sell" the ways they can help and assist active self management and avoid "Tier 2" type services/investigation/treatment quite as much as us. People actually coming wanting and expecting Ax/Info/rehab seems to be dwindling.
Update: 4 anyone following my odd knuckle - repeat urate was normal so presume not Gout. Hand consultant agreed seems unusual but likely bursitis. No further action as it's somewhat improved and no pain or dysfunction. Likely related to glove use/friction 🤷♂️ 💼
Ok physiotwitter so why have I got a tenosynovitis/bursitis in my 3rd MCP.
Please advise if this looks like something different - had a course of ABx and Naproxen, awaiting bloods. Similar issue in knee few months back.
First experience of Red Whale
@GP_Update
today, slick website and some very handy free webinars for MSK / Rheum /Paeds Red Flags- perhaps useful for FCPs and those looking towards the MSK Diploma via
@pcrsociety
@MSKEdNet
👨🎓Calling educators in Heathcare👩🎓
Do you support students? Supervise staff? Developing yourself in the education pillar of advanced practice?
What do you think of this supervision model with prompts? Feedback welcomed.
Googledrive PDF: