I am a big advocate of my interns reading case reports.  Yes, this is low level research but the last time I read a systematic review, it left me with a big hole in my brain.  Some show interventions directly that help a patient, while some are differential diagnosis and clinical reasoning cases.

This is what I did as a student to give me ideas of how to treat, because we don’t learn this well in school!   It really helped me in the past and I try to translate this knowledge forward to our future therapists.  Makes you think about the picture below provided in AAOMPT conference 2010 by Cook & Sizer.  It is not a bad idea to flip the triangle every once in awhile.

Physical Therapy. Courtesy AAOMPT 2010 by Cook & Sizer
Physical Therapy. Courtesy AAOMPT 2010 by Cook & Sizer

Diagnosis and Management of Ankylosing Spondylitis Masked as Adhesive Capsulitis: A Resident’s Case Problem

Physical Therapy
Physical Therapy

Written by Chelsea Jordan and Dan Rhon in JOSPT October 2012, I find this report is not only an eye opener of practitioner’s not using clinical reasoning, but a great review of ankylosing spondylitis.  It is well worth your read and will aid in your differential diagnosis of a mechanical vs non-mechanical cause of spinal pain.  Quite detailed, it provides criteria for inflammatory back disease, differential diagnosis based on several features, and the appropriate call to refer out.

I wrote a piece earlier this year (part 1 here and part 2 here) about a patient arriving with positive SIJ pain from combination of provocation tests but had underlying AS.  These two can go hand in hand.

Use of Thoracic Spine Manipulation in the treatment of Adhesive Capsulitis: A Case Report

Physical Therapy
Physical Therapy

Written by Joshua McCormack in JMMT, this case shows the benefit of thoracic manipulation that was implemented after the 10th visit in a patient who was not showing improvement with typical glenohumeral and scapulothoracic manual therapy and exercise.  I typically incorporate this approach much earlier in my treatments but was a good learning experience for the intern of mine at the time to not give up but go back to the drawing board to find what else can help this patient.  Shoulder elevation improved 25 degrees after this intervention so definitely a ‘boost’ for this patient! This condition is self-limiting yes, but depressing in my opinion in that who wants to wait up to 18 months for it to improve!? Would have been interesting to see results and lower visits if manipulation would have been implemented at day 1 or 2.

We are seeing more and more benefits of thoracic spine manipulation in the literature lately so definitely a good skill to have.

Differential Diagnosis of a patient referred to physical therapy with neck pain

Physical Therapy
Physical Therapy

Written by Jessie Mathers in JMMT, this is an excellent case report highlighting a simple concept that was missed by prior practitioners (7 visits total prior to referring to PT!) to detect a non-mechanical source of neck pain.  This concept is reproducing the concordant symptom.  We all do this daily and sometimes it seems thoughtless until something does not line up correctly.  This case underlines reproducing concordant symptoms through a clinical reasoning, patient response and assess-reassess model.  All of these will give the therapist the most confidence in determining if a patient is appropriate to continue our services or not.  This is especially important if you do practice under Direct Access.

Oh and even better, this came out of Duke, right down the street from me.  Go Blue Devils!

Did you read a case report this year that is worth sharing? I would like to hear from you.  

Have a Happy New Year!



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