Today, I went to Wake Orthopedics in Raleigh, NC by Brier Creek to shadow Dr. Mark Wood and Dr. Alan Summers. I shadowed Dr. Summers in the morning where we actually had a patient that was exaggerating the seriousness of his injury. We took extensive x-rays to figure out what the problem was including x-rays of his pelvis, back, and knees. He claimed that he had arthritis in his knees; however, arthritis can be detected on an x-ray and there were no signs of bone spurs or small space between the femur and tibia. When Dr. Summers did a pressure test to test the strength of the ligaments in the patient’s knees, it was found that he was “faking” or exaggerating the weakness of his ligaments by purposely trying to make them weaker. This is known as “cog wheeling”. It’s different than legitimate weakness because the limb will slowly and smoothly move backwards. In “cog wheeling”, your brain and what you are trying to make your body do are conflicting. Thus, the limb will twitch back and forth as opposed to moving back smoothly.
When working with Dr. Wood in the afternoon, he’s mainly a knee and shoulder specialist, so we had lots of arthritis cases that came in and injuries to the clavicle. A particularly interesting case was one that involved an ATV accident where the patient had nearly complete range of motion of his shoulder, but had a “bump” sticking out of his shoulder. We performed the x-rays and come to find out that the patient completely tore through their
tendon that attaches their clavicle to the muscles of the upper arm extremities. The patient suffered a grade 5 tear (out of 6 grades) of this tendon and yet they only came with complaints of slight discomfort. Dr. Wood informed me that these injuries up until 2 years ago would always be treated with surgery; the sooner the better. However, thanks to innovations and extensive research and records, this injury can now be treated with extensive physical therapy as long as the patient is comfortable with the bone sticking out. If discomfort persist longer than the patient can withstand, surgery can be performed. The recovery time for this injury with and without surgery stands to be the same. Evidently, it’s up to the patient on whether they want to pursue surgery or not. This just comes to show how techniques and innovations in medicine are constantly evolving to make treatments more efficient.