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Trust Your Physical Exam

I met a ballet dancer/teacher this week who was sent to me by her insurance carrier. She was weary of me and and clearly stated that she thought I was a shill for the carrier and I would almost certainly deny her care. She said it with a smile which was my first clue that there was more here than meets the eye.

Her story involved a second job where she worked as a counselor with disabled children. She was in a use of force incident where she had to restrain a violent child with both arms. There was a great deal of thrashing and punching and the result was severe neck and back pain. That was 3 years ago and she had lost her ballet career as she had not improved with chiropractic, physical therapy, acupuncture and countless trigger points and epidurals.

As I examined her she complained about severe biceps tendinitis. My exam was suspicious for shoulder instability and a labral tear in both shoulders. After confirming that nothing had ever relieved her pain and that her epidurals did not give her even a few minutes of relief, I asked her to trust me for one minute. She reluctantly agreed to allow me to manipulate her shoulder and I performed a posterior glide and stabilized her humeral head. Fortunately she didn't have any capsular contractures. She looked at me with wonder and I said I know. She said how did you do that? I said you don't have any neck or back pain anymore on this side do you?

Needless to say the answer was no. We repeated it on the other side and she had the same response. I reviewed her imaging which showed some mild disc bulges and no real indication for pain management. We discussed shoulder instability and how it can cause trapezius and latissimus spasm which can feel like neck and back pain. As the information sank in and she connected the dots, she started to tear up and then she began to sob. Three years of her artistic career gone and arguably none remaining at this age was a lifetime of loss for her.

She left and came back an hour later. She had more questions but mostly she wanted to thank me. It is possible to find satisfaction as a physician in almost every circumstance. I am reminded every day of the value of a thorough physical exam. And on this day, this patient, she reeducated me on the impact we have on our patients lives.


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