Patient AB was a 48yo female who came with very acute shoulder pain. So acute that it was painful for even her clothes to be touching her shoulder. She had had this for nearly 3 months and had had 25 kiné sessions. With no relief from her symptoms. She came to me as a last resort as she had just had Xmas with her inlaws and had to cook and cater for her family whilst in so much pain.
She was in tears.
Exhausted and fed up.
I asked her what caused this pain, she didnt know, all she had done was drive her daughter to school, drop her off and then as soon as she was in the car this searing pain took over.
So I asked her did she get any bags from the car, or anything physical? No she answered she got out of the car, kissed her daughter and waved and got back in the car.
I asked her what the kiné had done, and it was a pretty thorough decompression of the shoulder. So there was no point in repeating this as the patient had had no good response.  So it couldnt be coming from her shoulder.

But she waved goodbye to her daughter.

Now waving comes from the elbow.

I asked her to lie down on the table and assessed her elbow. The muscles around it were heavily guarding it. I asked her permission to manipulate it and 3 seconds later after I had manipulated the joint the patient sat up and moved her shoulder, then smiled, then burst into tears. 99% of the pain had gone.

It was all from the elbow. Elbow pain radiates up to the shoulder. She didn’t even need to come back for a second session. Elbows are really easy to manipulate into their correct position.

#weloveanatomy

Patient CD was a 36yo female who was staying in Juan les Pins for 3 days. She had just started a business and this was her first event. So she was under a lot of stress. She flew in the day before and 3 days previously had started having severe headaches. She went to a doctor in her country and was given some tablets. They didn’t work. So I was called in to see if I could give her some relief.
I assessed and noted that she was on medication and had seen her doctor a day before. I decided to ease the tissues very gently and did a calming and cranial session with some specific but gentle stretches. We agreed that I’d see her the next day.

The following session, she told me that the pain had almost vanished, she was really happy as had had a good day with her clients. I repeated the treatment, very gentle plus cranial. We agreed to have a session after her final client day, the following day.

I turned up and she was in tears, the head pain was so intense again. I was perplexed, I had repeated the treatment that had given her a great response. I hadn’t done anything different.

Then she said… ‘when I look at my hand I don’t even think it’s mine’
Which sounds a bit odd, even silly really, but to an anatomist it screams that there is a tumour in her brain. Now I was kicking myself for not having done a cranial nerve test, and the reason I didn’t was that I had assumed the doctor had done one. Maybe he had and hadn’t picked up any changes. I don’t know. But my concern now was this lovely young patient and what she needed.
She was booked on a flight the following morning. She needed hospitalisation. But wouldn’t she be better being at home surrounded by her family, rather than stuck in a French hospital?. She was Danish and their health care system is great.
But I didn’t want to add any more stress to her so what I decided to do was to let her go back to Denmark but go straight to hospital from the plane. I wrote her a letter to take and urged her to go direct to her doctor. In the letter I wrote that I suspected she had a ‘space occupying lesion’, this is the medical term for a tumour.  So if she opened it she hopefully wouldnt be to anxious.
I asked her to message me once she had been to her doctor.
She flew back home the next day, I was worried all night hoping I had made the right decision for her.
She went to the docs, he sent her straight to hospital, she was operated on in the following few days and a large tumour was removed. It was benign. Hooray. 3 weeks later she was out of hospital and back at work setting up her next client event.

The moral of the story? Don’t ever not tell us how you feel, no matter how odd or silly it sounds.

We have a saying which goes, if you let the patient talk long enough they will tell you their diagnosis.
When you say its a ‘tickle’ a ‘shoot’ a ‘stab’ type of pain, they all indicate different structures in your body. So be as descriptive as you can and you’ll get a correct diagnosis, quicker.
And the moral for me, is that I learnt, NEVER to assume what another medic has done!