Case #46 Robert Medcalf

case 46 thumbnail.png
case 46 thumbnail.png

Case #46 Robert Medcalf


In case #46 I'm joined by Mr. Robert Medcalf who presents a 50 year old female, a cafeteria worker, who presented with the chief complaint of headache, bilateral arm and hand pain and paresthesia.
This is one of those patients that can allow us to confuse ourself and "chase rabbits" if we're not careful.  Robert breaks it down for us in a succinct way and with good sound reasoning. (1hr 5min 17sec)

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Robert presents so many valuable take-aways in this case, including:

  • a review of the patient's history,

  • the initial findings on physical exam,

  • his thought process through the repeated movement testing,

  • day 2 and 3 and the necessary alteration of loading strategies

If you know Robert at all, you'd know he's technically precise in his clinical reasoning and you won't find too many therapists more proficient in a mechanical examination and eliciting centralization than he is.

This is a patient he'd seen on a recent part B course he taught.  It's one of those patients who shaded in the majority of the upper body on the body diagram.  She complained of multiple symptoms and showed different symptoms responding to different directions and loads.

Among the topics we dive into deeper include:

  •  what your next question should be when the patient describes bilateral arm and hand paresthesia
  • questioning to rule out central cord compression
  • how to ensure you're not missing anything in particular direction before moving on to the next direction
  • what you should investigate when the patient describes they're better with their movement but not remaining better
  • a tip on how to be sure your patient understands their home program and won't come back demonstrating what you wanted them to do incorrectly
  • and on and on!