Andrew Windass

@AndrewWindass and myself have just finished our 4th radiographer-physiotherapy interdisciplinary team meeting. 2 AHP teams having a chance to discuss cases (clinical examination & xrays findings) seen by FCPs and diagnosed by radiographers. Every week is more interesting

@neilstewart101 @AmieCoombs2 @PhysioMACP I would say over-coverage and sclerosis bilat. with Cam on right. Also subchondral cysts on right femoral head and is there some signs of remodelling?

An interesting right hip in clinic this morning. (posted with consent). Anyone who has been on our course (@AmieCoombs2 ) want to comment on it? New course date coming imminently #physiotherapy #FCP #MACP #Xray #Hip @PhysioMACP

@tomgoom @DrJN_SportsMed @suzy_speirs @afranklynmiller @tobyrsmith @tommymonkeybob @SportDocBedford @BrechtConinck @angiejphysio @function2fitnes @theEndurancePT Both great suggestions, much appreciated.

@AndrewWindass @DrJN_SportsMed @suzy_speirs @afranklynmiller @tobyrsmith @tommymonkeybob @SportDocBedford @BrechtConinck @angiejphysio @function2fitnes @theEndurancePT There isn’t a lot of evidence for conservative management of anterior CECS but yes activity modification is important. I’d assess gait too (see if they’re over striding and dorsiflexing++ at terminal swing) and footwear. A 5-10% step rate increase and lighter shoes may help

In researching our new video series on shin pain I discovered a new delphi study on Chronic Exertional Compartment Syndrome including 5 diagnostic criteria that we’ve summarised in this slide👇 Here’s the paper if you’d like to get your geek on! ➡️ pubmed.ncbi.nlm.nih.gov/35904751/

@TaylorAlanJ Yes but find in most cases it's redundant. All require d-dimer as per NICE guidelines and I would assume in most physio settings this isn't accessible so would require onward ref to DVT services /A&E.

MSK #physio ... a QUESTION If you suspect a patient may have a deep vein thrombosis (#DVT), do you use the Wells Score as part of your assessment? #PhysicalTherapy #Physiotherapy

@neilstewart101 @AmieCoombs2 Thanks Neil, always good to hear your thoughts. Assuming you mean right hip as in right of image?

@AndrewWindass @AmieCoombs2 Hi Andy, awesome thanks. Here are my additional comments on the Xray. 🤙

Another great XR - lots going on here. Anyone want to comment on what they think is going on with both hips?? @AmieCoombs2 #physiotherapy #FCP #Hip #XRAY

@gsingh1902 "We've booked you in with in-house physio who can spend the first 15minutes of their consultation explaining why your nerves aren't squashed"

Reassurance text 🧐

@BalakumarJit @northwoods1980 Was just going to say, femurs externally rotated as no lesser trochanters visible

@northwoods1980 Also X-rays are rotated, not weight bearing, and no Dunn lateral or faux profile.

What do you all think of this case as well as the protocol from this clinic. Young patient. Anterior hip pain. Only comes on with walking greater than about 1/2 a mile. No trauma history. I don’t have any more on the clinical exam.

@dysplasia_hip Interesting xray. Looks very anteverted bilat. Right hip very internally rotated, left looks externally rotated. Interested to know what people's thought are on right sup. pubic rami.

@DrJN_SportsMed No it doesn't, like you say recipe for disaster

@AndrewWindass 🤦 god no don’t stick acu needles in - asking for trouble and also makes no sense does it.

Thread -🚨🚨🚨 Anterior knee pain is super common - understandably, we tend to think of the patellofemoral joint, Hoffa’s fat pad or proximal patella tendon as the main culprits But there are other less common causes that might not necessarily be on your clinical radar….

@DrJN_SportsMed Thanks for the reply. First thoughts certainly wouldn't be to inject, but I'd also read about high risk with olecranon bursitis as well and wasn't sure of mechanisms behind this. Have also overheard people talk about managing this with acupuncture needles but we won't go there!!

@AndrewWindass Ultimately key message is most bursitides can be left to resolve with non invasive methods so can simply mitigate infx risk by leaving it alone! Risk - benefit ratio.

@DrJN_SportsMed Thanks for the excellent thread. Would you mind explaining why there's a high risk of infection with injecting bursitis'? Or suggest any reading on the topic.

Bursitis - Very easy to pick up - here a huge prepatella bursitis Compression & friction usual culprits but beware a rheumatological driver Exercise caution +++ with putting needles in re risk of infection

@DrJN_SportsMed Did he have any risk factors other than previous stress #?

With consent Elite male runner 20s 6/52 ⬆️ L groin pain ➡️ to thigh initially warms up now stops him, night pain Rx as hip flexor strain 🙄 Video ➡️ Hop test R vs L +ve FADIR US - periosteal reaction femoral neck ? stress # hip flexor in an endurance runner?think again