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A Rare Case Study From 1996
Untold Physio StoriesFebruary 14, 202400:17:3632.96 MB

A Rare Case Study From 1996

Today's guest, Dr. Mohamed Almubiadin, a DPT and current ATC student talks about finding having two rare cases within weeks of each other. Being a new grad DPT and current ATC student, he asked lots of questions in the history and did research until he found a rare differential diagnosis from an old case study in 1996. Have you ever heard of this? Are you now going to ask about any recent illnesses in your history?

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Join the revolution now at copperhandpt.com Untold Physio Stories listeners get 50% off their first month with code MMT50 [01:00.000 --> 01:13.000] and there's a free trial available. Sign up now. I use it every day in a clinic for virtual and my visits. I just speak to the patient and at the end, hit copperhand and a soap notes generated. I love it and you will too. [02:00.000 --> 02:11.000] You're good. You're good. It's Dr. Alm, Alm, Biden. Are you sure? Yeah. If you want to hear how it sounds in Arabic, it's even better. [02:11.000 --> 02:20.000] Yeah, sure. So my full name is Mohammed Alm, that's how you say my full name in Arabic. Oh, nice. [02:20.000 --> 02:28.000] You know how to pronounce my last name? Oh, man. Let's see. I'm going to butcher this, religioso. [02:28.000 --> 02:34.000] Yeah, well, it's pretty close. You know, I don't know why people don't even get the Italian version, right? But it's really Hioso. [02:34.000 --> 02:42.000] Hioso? Okay, really Hioso. Okay. So the G isn't pronounced. The G is an H. Spin. Okay. Beautiful. I can do that. [02:42.000 --> 02:50.000] Right. So anyway, I was on LinkedIn one day and perusing just whatever the feed and Mohammed's interesting case came up. [02:50.000 --> 02:56.000] Why don't you first give it like a quick summary of where you are, your practice and everything, and then your case? [02:56.000 --> 03:04.000] Yeah. Well, where I'm at, I'm currently in Dallas, Texas. And then again, my name is Mohammed Alm, and I'm a licensed physical therapist. [03:04.000 --> 03:13.000] I'm actually also a student athletic trainer going through a master's of athletic training program here in Arlington, Texas as well. [03:13.000 --> 03:25.000] And by where I'm currently practicing, it's kind of, it's kind of a tricky answer to a tricky question to answer because I'm currently doing a lot of like contract work and I work with a lot of professional athletes on the side. [03:25.000 --> 03:32.000] But I also do children's home pediatric, but I also do some hospital contracts. So I'm a big Swiss Army knife right now. [03:32.000 --> 03:39.000] It just kind of helped me get by as I'm getting through school. But yeah, so that's a little bit of a quick background. [03:39.000 --> 03:45.000] So I'm going to the University of Mary Hardin Bay, or to get my license and physical therapy. [03:45.000 --> 03:50.000] And again, I'm currently an athletic training school for my master's at UT Arlington. [03:50.000 --> 03:56.000] So, yeah, no. So the case that we're going to be talking about today, it's a case that I had about two years ago. [03:56.000 --> 04:12.000] It was my first year out of practice in an outpatient setting. And I had an individual come in, a very young male who came in college student and was complaining of shoulder pain, scapular pain. [04:12.000 --> 04:24.000] And he came to me and he was really, he felt as if his, the way he was ascribing it when we were kind of going over his objective, he felt like his shoulder blade was popped out, popped out of his socket. [04:24.000 --> 04:34.000] And that's just how he was ascribing it. And so I was confused. And like, as I was getting his objective, I was like, did you have any kind of direct trauma? [04:35.000 --> 04:42.000] And he kind of anything along anything, anything of that nature, do you play any sports? He's like, I don't play sports. I play recreational basketball. [04:42.000 --> 04:48.000] Sometimes I haven't had any falls. I haven't had any accidents. Nothing. Like, I don't know what's happened. I woke up with this thing. [04:48.000 --> 04:55.000] And I was like, okay, well, let's like, let's go ahead and have you. If you don't mind, take off a shirt, turn around. Let me just take a look at you real quick. [04:55.000 --> 05:03.000] And lo and behold, take off a shirt. And it was like the most significant, severe scapular wing I had ever seen. And it was unilateral too. [05:03.000 --> 05:16.000] That was even more weird. And the fact that he was just saying that he hadn't had anything, like, hadn't had any injuries prior, never had any shoulder issues and just woke up with it. That was just, it was beyond me, it was stumping me. [05:16.000 --> 05:24.000] So, and I'm a new grad, you know, coming out of PT school and I'm looking at this and I'm like, man, I'm stuck. I don't know where to go here. [05:24.000 --> 05:32.000] So, I relied a lot on my subjective skills as I've kind of mentioned in that LinkedIn post, but I just kind of kept asking more questions. [05:32.000 --> 05:42.000] You know, have you had any, are you taking any medications? Do you have any sicknesses or any illnesses that you've been dealing with? [05:42.000 --> 05:53.000] And as we're going through everything, no significant past medical history, no significant change or hasn't taken any medication. [05:53.000 --> 06:03.000] Again, everything was fine, right? I won't even go into super big detail. But he was mentioning, he kind of stopped me at one point and was like, you know what? [06:03.000 --> 06:13.000] I do remember two weeks before this happened, two to three weeks, I had mono. And I was like, okay, you know, in the moment I'm like, okay, I got to write this down. [06:13.000 --> 06:18.000] And I was like, I don't know how this helps me, but I'll just write it down anyways, right? So, right down mono. [06:18.000 --> 06:27.000] And he's like, yeah, you know, I had a lymph node. Like my lymph nodes are like really swollen and just kind of like, you know, start up right here in my throat. [06:27.000 --> 06:34.000] And, you know, I was kind of going through it for a few days, but I mean, other than that, you know, it was fine. I was like, okay. [06:34.000 --> 06:42.000] So, after everything said and done, I was like, all right, well, you obviously have, you know, your typical, you have a serrated interior weakness. You know, I'm looking at you. [06:42.000 --> 06:53.000] It was like, let's see what we can do here. You know, have you come back in, we'll try to strengthen your shoulder blade up, try to strengthen this muscle that I feel like is not working adequately. [06:53.000 --> 06:59.000] But let me do a little bit more research and kind of get back to you and kind of come back and went and did some research. [06:59.000 --> 07:07.000] And I think all I literally typed in is I went back to my laptop. I typed in. I said, mono nucleosis, scaphone, I think I typed that into Google. [07:07.000 --> 07:12.000] And nothing, nothing, nothing, nothing, nothing scrolled. And I found like one case study. [07:12.000 --> 07:28.000] And this case study was a 15 year old male from 1996 that had Epstein bar virus, which apparently also leads to the diagnosis of mono, cause mono, which then causes neuro inflammation. [07:28.000 --> 07:40.000] And causes a long, cause for this, for this specific person, cause a long thoracic nerve palsy, which is the same nerve that innervates the serrated interior. [07:40.000 --> 07:48.000] And I was just like, oh my God, this is the, this is the coolest thing ever. It's the most interesting thing I've ever seen. So I was like, okay, well, I'm looking more into this. [07:49.000 --> 08:04.000] So I was doing some clinical work for my athletic training program at a high school and a child comes in with the exact same subjective kind of presentation that my first one that I mentioned him in with. [08:05.000 --> 08:23.000] And this kid, again, had gone through all the diagnostic imaging, nothing to do with nerves, but had done, you know, x-rays, CT scans, MRIs, and everything had come up negative, which is to be expected if we're assuming that what I found was correct. [08:23.000 --> 08:32.000] You know, again, I didn't mention this for my first patient, but my first patient also went through all those diagnostic imaging tests as well. [08:32.000 --> 08:37.000] Again, all the doctors were stumped. No one really knew what exactly was going on. They just didn't really understand it. [08:37.000 --> 08:48.000] And so this kid comes in, same history, the parents are really burnt out with going to the doctors. They don't want to do it anymore. They're over it. [08:48.000 --> 08:57.000] And they just at this point, are just like, let's just do what we can and see what we can do. And he's seeing a physical therapist and isn't really helping much. [08:58.000 --> 09:05.000] Just again, based off of what we talked about, if we're assuming it's a nerve palsy, then, you know, just strengthening it up isn't really going to do much anyway. [09:05.000 --> 09:11.000] So again, it's just one of those things where like, there's just, I think there's a disconnect in understanding like what's happening with this patient. [09:11.000 --> 09:19.000] But it's funny because the first thing it was after I had asked him the basics of just the questions, the very first thing I asked him was, have you had mono? [09:20.000 --> 09:30.000] And he goes, actually, yeah, I did have mono. And I was like, when did you have it? Was it how far or how close was it to when this shoulder issue started happening? [09:30.000 --> 09:38.000] He was like, man, I think it was like a month before. And I was like, hmm. And then my preceptor, the guy that was the person that's with me at the high school, [09:38.000 --> 09:44.000] just looked at me like, what a weird question to ask. Why are you asking my mono? And that's where we had that conversation. [09:45.000 --> 09:50.000] But anyways, I say all this. And the reason why I decided to show this on LinkedIn, because I was like, oh, man, it's happening again. [09:50.000 --> 09:55.000] Like, I'm seeing this. Like, what are the chances like this happened twice? And I'm only three years out. [09:55.000 --> 10:03.000] You know, it's more common. And no one's looking at it because there was only one case report from 1996. [10:03.000 --> 10:09.000] Exactly. Well, now there's, there's a few more now. Like there's, so I went when I was reviewing it with my preceptor. [10:10.000 --> 10:19.000] I asked that question. I brought up my previous case that happened about a year or two ago. And, and yeah, we found like two or three more case studies that were really similar. [10:19.000 --> 10:30.000] But it's, what do they do? Like antivirals or, I mean, like what? So, so what they did was they all kind of essentially figured out that they might have had Epstein bar virus prior to. [10:30.000 --> 10:38.000] So the diagnosis, the word we're looking for using right now is called multi. Oh God, I can't remember it now. [10:38.000 --> 10:47.000] It was, it's multi. I'll have to go back and check. I'm so sorry. I can't remember this off my head. But there's a word for it. [10:47.000 --> 10:56.000] There's a specific word that basically is, is the cause of that leads to the, that leads to the policy. [10:56.000 --> 11:03.000] But this word is diagnosis comes from Epstein bar, right, which then leads to mono. [11:03.000 --> 11:10.000] So individuals have mono thinking that they just got mono out of the blue. Well, actually that this ends up happening to. [11:10.000 --> 11:20.000] Well, actually it looks like what that what might have actually happened was that they got Epstein bar bar, which led to the mono, which led to the policy, right? [11:20.000 --> 11:30.000] Because the Epstein bar viruses was actually that was causing the neuro inflammation and the, and the, the, the nerve policy, the nerve, the nerve irritation. [11:30.000 --> 11:35.000] And the mono that happens after is just, you know, the after the fact. [11:35.000 --> 11:44.000] And so I just find it really interesting because, and I think you're right. Like you said, I mean, it, it either it's something that just came up. [11:44.000 --> 11:48.000] You know, people aren't really looking into it. So maybe that's why it seems so rare. [11:48.000 --> 11:54.000] But I don't know. It's, it's just so fascinating to me. And I got so, so intrigued and look into it. [11:54.000 --> 12:00.000] But yeah, it's probably a question that we, I mean, that's why I love cases like this, even if it doesn't necessarily tell us what to do with it. [12:00.000 --> 12:08.000] But it probably tells us better questions to ask. Yeah, yeah. I mean, 100%. And I think that finding that missing piece is so important. [12:08.000 --> 12:12.000] But better questions to ask is so important. I'm a really big believer in having a very thorough subjective. [12:12.000 --> 12:17.000] And I think they teach us this in school, but you know, we're all like young and we're like, I just want to do all the special tests. [12:17.000 --> 12:22.000] I want to figure it out. It's not even that. I just think that you're a newer grad, right? [12:22.000 --> 12:28.000] Right. And you, you tend to ask better questions than someone who's 26 years out like I would. [12:28.000 --> 12:32.000] Right. I guess that makes sense too. That's a good point. You know, because I asked these questions. [12:32.000 --> 12:42.000] Because we have like experience, right? Experience. Yeah. I don't recognition. And I think I can, when I don't see patterns, it's almost like, hmm, what am I supposed to ask again? [12:43.000 --> 12:52.000] Yeah, 100%. You guys are ready. Like, since you don't have all the pattern recognition yet, you just fall back on the questions that you're asking. [12:52.000 --> 13:11.000] I mean, it is a similar case. If you haven't heard my podcast just recently, someone came on and said that his student found that a patient who was having like low back pain and like these GI issues actually just found out that they were constipated, like severely constipated. [13:11.000 --> 13:18.000] And it's like, oh, I wouldn't have asked that. You know, but the student asked that. The new grad asked that. Like the bowel movements and stuff, like the questions. [13:18.000 --> 13:23.000] Yeah. Oh, wow. Yeah. See, that's great. I don't think about those questions either. Yeah. That's what I mean. Yeah. [13:23.000 --> 13:30.000] And he just happened to be like asking questions and then that just came up like, oh, yeah. You know, like the patient had severe constipation. [13:30.000 --> 13:37.000] Yeah. Yeah. No, it's, it's, it's crazy how that works. But like I said, I'm a big believer in, and that's subjective. [13:38.000 --> 13:50.000] Because if you do a really good subjective, you're going to find out you're going to find something. Yeah, you're going to find something and you're probably going to even have to do like 90% of the tests that you were planning on doing anyways, because you already have a really good idea of your diagnosis by then. [13:50.000 --> 13:58.000] But I bring that up. And like I said in the LinkedIn post, I bring it up as a conversation to have with like the community is like, you know, like, you know, the subjective is so important. [13:59.000 --> 14:08.000] But also, you know, when you get to those points of like, Oh, I just, I don't know what to do or anything. I don't, don't write the patient off. Like, keep digging, keep looking, keep trying to find something. [14:08.000 --> 14:13.000] Don't just kind of like go back to, Oh, you know what, we're just going to strengthen it up. I'm like, here, send you off to the floor. [14:13.000 --> 14:21.000] We'll figure it out later. We'll do whatever we can. But I'm, again, we got to this point with this patient and, you know, I was able to present the case study to him. [14:21.000 --> 14:34.000] And I get it, get some input. You know, we, we could always push for an EMG, but then at the end of the day, at that point, it was like, you know, what's an EMG going to tell us? Like the nerve doesn't work. Okay, then what? Like, what's the next step after that? Right. [14:34.000 --> 14:43.000] So, and the case studies, you asked what they did, they did provide, you know, obviously, well, they didn't need to because these guys were presenting after the fact. [14:43.000 --> 14:55.000] So there was no, like, medication actually being involved in their treatment. But they actually reverted to strengthening the essay, periscope for their muscles, yada, yada, yada, all the basic stuff that you would already know as a physical therapist. [14:55.000 --> 15:08.000] And then what they actually found was two years later, these guys weren't doing it for two years, but they found that when they would, like, followed up with their patient by a year or two, they would spontaneously just improve. [15:08.000 --> 15:24.000] So, nerves regenerate, we know that, you know, and I think that me as a student, me being a new grad, but like having that student brain, I was like, I want to figure this out, I want to get this done, I want to do this now. Like, how do I fix this now? [15:24.000 --> 15:36.000] Go get an EMG study, go to the doctor, go do this, and you, like, try to push for all these, all these countermeasures to get, just to make yourself feel better about like, yes, I got it right or yeah, whatever the case may be. [15:36.000 --> 15:44.000] But we have to remember at the end of the day, what is it that we, what can we do? Like, okay, yes, let's get to that point, yes, you're right, what do we do now? [15:44.000 --> 15:50.000] And I had that conversation with my preceptor too, it's like, okay, even if this is the case, you know, how do we fix it? [15:50.000 --> 15:58.000] If we push for all of this, we push for him to go see a neurologist, we push for him to go get an EMG, we push for all these extra things, what are we going to get out of it? [15:58.000 --> 16:04.000] Like, how does he improve? And you've had to stick a step back and just be like, you know what, you're right, like, what, what can we do? [16:04.000 --> 16:22.000] So we just, like, in this moment, you know, we, all we can do in our scope, and it's kind of, we have, we kind of had that conversation with the athletic trainer, and then it also pertains to physical therapists as well, but like, you have that conversation where you're like, you know, I think within our scope, it's really just important for us to understand that we can have those [16:22.000 --> 16:27.000] educating moments with the patient, making sure that they understand what's going on to the fullest of our abilities. [16:27.000 --> 16:30.000] Hey, this is our suspicions, we think this may be happening. [16:30.000 --> 16:33.000] Here's some like research to back it up if you're interested. [16:33.000 --> 16:40.000] In our case with this child, we call the parents and explain to them everything as well in the high school setting, I mean. [16:40.000 --> 16:45.000] And then at that point, you just have them get in control of the rehab, you know, what would you like to do? [16:45.000 --> 16:51.000] Here's what I can do for you, here's what you've tried, you know, let's just kind of go from there. [16:51.000 --> 16:54.000] But I think those things are just important too. [16:54.000 --> 16:56.000] Yeah, awesome. [16:56.000 --> 16:58.000] Well, thanks for thanks for that. [16:58.000 --> 17:04.000] Yeah, you know, if you ever have a link to any of the cases or even like pictures, I think you may share pictures of LinkedIn. [17:04.000 --> 17:09.000] I can potentially post them along with like the blog version of this podcast. [17:09.000 --> 17:20.000] But yeah, if you guys have any comments, any listeners or any similar cases, any light bulbs, make sure to comment on anywhere I post this on social media. [17:20.000 --> 17:23.000] Thanks again, Muhammad, for coming on the podcast. [17:23.000 --> 17:25.000] Yeah, absolutely no problem. Thank you for inviting me. [17:25.000 --> 17:26.000] Alright, yeah. [17:26.000 --> 17:29.000] Hey guys, thanks as always for listening. [17:29.000 --> 17:34.000] If you like this podcast, make sure to give us five stars wherever and hit that subscribe button wherever you listen to podcasts. [17:34.000 --> 17:36.000] And as always, you guys have a great day. Transcription results written to '/home/forge/transcribe.sonicengage.com/releases/20240210005325' directory