Jan 27 (edited) • CASE STUDY CORNER
MY FIRST CPG CASE STUDY BREAKDOWN OF THE YEAR!!!
You guys wanted my case study break down on the last case? Well, HERE IT IS!
I am not going to word vomit on here, I am going to keep it succinct & clear - Time is $$!
DDX -
1) Wrist = CPT pathology (mod/chronic) ; secondary transient median nerve neuritis (mod/chronic) ; muscular overload symptoms of wrist flexors/extensors (mod/chronic) ; L > R
2) Neck = ?Cx spine Disc pathology (mod/chronic) ; ?Multi-level stenosis ; C6-C7++ (Mod) ; radiculopathy ; postural overload symptoms of cx spine stabilisers/scapulothoracic stabilisers (mod/chronic)
The second DDX is purely a QUERY!
My hypothesis is that is is CPT pathology w/ secondary neuritis ; the above is just to show how i structure my DDX & problem list based on -
Locality/structure ; chronicity ; severity
Why do I believe it's wrist? Not because of the scan, but there were no Cx spine aggs leading up to the consult to point towards a Cx spine pathology ; nor could I reproduce the symptoms in the clinic.. Also, most Cx spine pathologies that cause a radiculopathy usually pass through the UL before they make it into the hand..
Mx plan -
A) Deep tissue massage through wrist flexors/extensors - 10 mins (both sides)
B) Deep tissue ; fire cup gliding ; fire cupping through neck/scapular/thx spine/lower back for maintenance - 20 mins
Rehab -
Priority - re-introduction of loaded gripping for wrist & elbow stabiliser conditioning before introducing loaded wrist extension movements
These exercises are to be performed with firm grip -
A) DB Hammer curls
B) DB Prone Hammer curls
C) Farmer carries - kettle bell
Volume - 15 x 2 ; 10 x 1
Frequency - x2-3/week ; begin with x2/week for first microcycle (two week introductory phase)
Plan -
x1 weekly treatment for next 4 weeks
If no improvement, no time wasting - straight for regenerative medicine opinion ; likely PRP
Then return to maintenance for x1/fortnight ; until x1 per month
Okay, plenty of word vomit LOL
Overall, you all did very well! I was very impressed by your objective testing & management plans.
However, the two biggest take home messages for you are -
A) Radiculopathy is NOT a diagnosis - it is a symptom of an underlying structural problem ; whether it be discogenic or stenotic in nature ; name the structure FIRST
B) No one made mention of PRP as an option if she doesn't heal, especially given that she is a bit older, her healing capacity is not the same as someone who is 25..
WELL DONE!
VOTE BELOW
Video breakdown
another post
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MY FIRST CPG CASE STUDY BREAKDOWN OF THE YEAR!!!
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