I am my own Clinical Case…
block one anatomy theory exam (upper limb & back) on Monday.
[1] 30-year old female patient complains of tenderness in right anterolateral wrist and base of thenar eminence. pain present on thumb flexion and abduction and is most noticeable when holding the handlebars of her bicycle and shifting gears while riding to school in the morning. since “handlebar palsy” usually affects the medial wrist and ulnar nerve, she figures she must be doing something very wrong and wonders if there is more than one way to ride a bicycle.
[2] the same 30-year old female patient comes back to complain about something else. this morning she experienced shooting pain when attempting to abduct, laterally rotate, flex or extend the left glenohumeral joint. fluid circumduction was basically impossible. there is tenderness on the top and anteromedial shoulder even when sitting in class doing absolutely nothing. this is her left arm — she is right-handed and can’t think what the heck might be causing this surprisingly sharp pain.
for anyone not familiar with anatomy theory block exams, that’s pretty much what the test looks like. you are given a series of scenarios (aka: clinical cases) and have to deduct which muscle, nerve supply, function, arterial supply, and/or side complications are involved. a set of multiple choice questions and answers narrow down whether or not you know what you’re talking about.
as for the answers…
fellow MED 1 students? what do you think? : ))
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September 17th, 2007 at 2:19 pm
flexion and abduction.
Hee. I love words.
September 17th, 2007 at 2:24 pm
Wow, med 1 is definitely different for us! We only have one block exam after 8 weeks of anatomy. How many weeks of anatomy do you get? How many block exams?
Hope you have a great time down there! All the best and good luck with your studies!!!!!
Oh, I still have that UBC bear that you sent me way back! What’s the comment count up to now??
.Pink
September 17th, 2007 at 2:30 pm
I say an amputation is in order.
September 17th, 2007 at 2:55 pm
[1] mouse palsy aka personal computer palsy
[2] idiopathic..
[3] Good luck!!
September 17th, 2007 at 6:50 pm
Well, I’d say you, um… I mean the patient, needs to tune up their bike’s brakes and suspension….and have a look at the way they angle their right wrist when they type (“straighten up and fly right…”). Take two asprins and call me in the morning ;)
I think you have “Medstudentitis”. Other symptoms include; developing S+S of life-threatening diseases (particularly tumors and sub-arachnoid haemorrhages) and suddenly realising you fit the profile of ALL the DSM-IV listed mental illnesses). Good luck!
September 17th, 2007 at 9:30 pm
I am unable to decipher all of the med lingo but from a cyclist point of view you may be gripping the bars too tightly. Check your seat height and your arm reach. You could be over/under extending to the handlebars. Cycling is all about position and being comfortable on the bike.
September 17th, 2007 at 10:30 pm
Adam beat me to it — I would suggest raising your handle bars (do it ever so slightly and ride for a few days between changes – maybe 0.5 cm at a time until you find the right height). Also, if you haven’t already done so, purchase a pair of cycling gloves with padded palms. Ta da! Problem solved. :))
September 18th, 2007 at 10:05 am
Hey, does this mean we can get you to diagnose our aches and pains now?
September 18th, 2007 at 6:26 pm
On the bike thing also: You might want to try rotating your shifter paddles from the factory setting to make them more natural for you so you don’t have to brace/reach to use them.
as for #2… rotator cuff, impingement, could be lots of things. Do some shoulder tests i.e. arc, impingement tests (passive forward elevation in slight internal rotation, passive abduction 90 degree external rotation, passive abduction 90 degree internal rotation) and see what happens :)