ninevirtues | I PASSED MY PRACTICAL!!!!! I got an A!

Right, I'll subside briefly now.....

I passed my practical. And, on closer inspection of the research grades, which were posted today, I got an A. As in a real A, not an A- (which has a lesser, though still salutory, effect on one's GPA.)

Yahooo!!!!!!

(The scenario for the practical was as follows: Older lady with all the symptoms of rotator cuff tendinitis. She reports that overhead activities are painful. When I raise her arm to 45 degrees from her body and let go, she can still hold it up, so it didn't look like a rotator cuff tear.... more like tendinitis. Oooh, Overuse, overhead, over age 65--- she has two of three. I'm pretty sure it's tendinitis.

So I report my findings to the professor (who I like a lot) and she says "Hm... you have done a very good exam so far, but you left one part out, and I think that would change your diagnosis."

Aaaaaghhhhh!!!! What, what, what?!! I asked the right history questions. I observed her posture. I looked at her scapular motion. I measured her range of motion. I did manual muscle testing to ascertain her strength. I screened for neck involvement (no) and elbow involvement (no). I did the special tests that, if she tested positive, would definitely say it's a rotator cuff tear, and it was not. WHAT could I be MISSING??! The other option is rotator cuff tendinitis, maybe with subacromial bursitis and biceps tendinitis thrown in. I said as much, and proceeded to do a test that would tell me if impingement was an issue. (It was not.) My lab mate made a you're-not-getting-it-and-this-is-bad face. (I agreed.)

And the professor said:

"It's a part of the exam that students commonly forget."

Aha! Duuuuh, I missed the joint mobilizations. If the joint mobility is limited in all directions, then this patient has adhesive capsulitis (frozen shoulder) which is masquerading as rotator cuff tendinitis.

I did the joint mobs. The professor leaned in to see me do them. I made a point of demonstrating all of the relevant ones.

"You find that the capsule is limited in all directions," says the professor.

"In that case, I believe she has the early stages of adhesive capsulitis, which is masquerading as rotator cuff tendinitis."

Next up:

Orthopedics final (1 PM Thursday)
Pharmacology Final (9 AM Friday)
Scorching evaluation of really irritating pharmacology professor (10:30 AM Friday)