Don鈥檛 let the title fool you, we are not ~actually~ keeping it together right now. With nine final exams next week, along with Part 1 NBCE Boards on Saturday, 鈥渟tressed鈥� feels like an understatement. It鈥檚 time for the time-crunch to finish the trimester with academic success, and maintain some form of mental and physical wellness while also cramming to prepare for the big five-hour, six-part national exam. If there is one way to survive all this, I believe it鈥檚 doing it together. Staying after school every day practicing orthopedic adjustments for our EM Extremities course, going through Boards practice questions, and creating group study guides for each class has relieved some of the stress. As they say, “Misery loves company,” so why not group up and at least laugh through the pain?
In my picture, you鈥檒l notice the smiles of my friends, Pete and Chris鈥erhaps, it was just a glitch in the matrix and they both momentarily forgot the anxiety of looming board exams, or maybe they鈥檙e finally getting comfortable with practicing physical exams and orthopedic tests. Chris was preparing to perform the Drop Arm Test (aka: Codman sign), in which Pete鈥檚 arm was passively abducted and then Chris would remove support above 90 degrees. This would cause Pete鈥檚 deltoid to contract suddenly and stimulate pain and hunching of the shoulder if there was a rotator cuff tear (specifically, a rupture of the supraspinatus tendon).
There are a variety of conditions that can affect the upper extremities, so it鈥檚 important to understand all the different types of signs and tests we can do to narrow down our potential diagnosis. Dr. Guadagno always emphasizes the importance of doing a battery of exams. In the case of a rotator cuff tear, we may want to perform a few other orthopedic exams specific to the rotator cuff muscles, such as the Apley test, Jobe鈥檚 test, and Hawkins-Kennedy test. It is also important to incorporate a few other orthopedic exams to rule out other conditions. For instance, we could perform a Dugas test (patient places hand of affected shoulder on opposite shoulder and attempts to touch their chest with their elbow) to rule out shoulder dislocation.
Not only is it helpful to 鈥減lay鈥� doctor and go through the physical exam steps and determine the diagnosis and management plan, but it鈥檚 also helpful to play 鈥減atient鈥� to understand what kind of symptoms are present and which orthopedic tests would be positive (indicating the condition(s)). It鈥檚 important to practice establishing a system for natural progression of a physical exam (H.I.P.P.I.R.O.N.E.L.). This also encourages us to find our 鈥渄octor voice鈥� and get used to interacting with patients. While we each get a turn to practice in our study group, we also rotate who grades our performance. With the rubric on the screen and orthopedic exams printed, we follow along with the doctor/patient interaction and help our classmate at the end realize what steps he/she might have forgotten or could improve upon. This tactic really helps you learn and improve!
Anyway, I should probably go back to studying鈥� Good luck to everyone on Finals Week!
