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The internet can be a great place to go when looking for exercises or information on treating patients. We have everything at our fingertips – we are seeing more patients come to into the clinic with a self-prescribed home program they got from Youtube. Youtube can be an excellent resource for exercises and information. However, is it appropriate for everyone? Are the exercises addressing the impairments? The most important thing….is, is it patient specific? Cassie and Steve sit down with previous guest Andrew Walquist, as they discuss the most common exercises seen on Youtube for tennis and golfers elbow. They give their thoughts on these exercises and suggest what they might do or change.
From your mouth to your feet, the hinge that feeds you and puts your socks on. What could go wrong and how to “fix it”. Join Hand to Shoulder and Dr. Boyd Lumsden, M.D with Hand to Shoulder Center of Wisconsin to discuss several diagnoses of the elbow joint, a surgeon’s perspective and recommendations for therapy.
Dr. Boyd C. Lumsden, M.D. is one of our very own skilled surgeons who joined Hand to Shoulder Center of Wisconsin in 2004. He is a board-certified orthopedic surgeon with a Subspecialty Certification in Surgery of the Hand. Dr. Lumsden provides complete comprehensive care to the upper extremity including the hand, wrist, elbow, and shoulder. He has a special interest in arthroscopic procedures involving the wrist, elbow, and shoulder.
Dr. Lumsden is a Missouri native who attended Southeast Missouri State University where he received his Bachelor of Science degree. He completed his medical degree from Northwestern University Medical School where he was respectfully a part of the Alpha Omega Alpha Honor Society. His orthopedic surgery residency program took him to the University of South Alabama and the University of Wisconsin Hospitals and Clinics in Madison, WI. He holds a fellowship in Hand, Upper Extremity and Microvascular Surgery from Wake Forest University Baptist Medical Center in Winston-Salem, NC. In 2003 he was the recipient of the Leonard Marmour Surgical Arthritis Foundation Award.
Boyd Lumsden, M.D. is married with two children. His outside interests include fly fishing, hunting, archery, snow skiing, and golf. He is also an active participant in many community events and holds a special association with the Mile of Music, a 4-day summer music festival in Appleton, WI.
Do you struggle prescribing exercises? Have that one patient who is not responding to the same exercise that helps every other patient? Have you ever thought about testing a one rep max as a part of some’s rehab? In this episode Ryan and Steve are joined by Mark Gallant DPT, OCS, FAAOMPT to discuss progressions, dosage, and loading for exercises. Mark gives examples of case examples with shoulder and elbow exercise progressions in this episode.
More about this episodes guest:
Dr. Mark Gallant is a physical therapist, board-certified orthopedic specialist, Fellow of the American Academy of Manual Physical Therapist, and certified in dry needling in Richmond, VA. Mark received his Doctorate in Physical Therapy from Old Dominion in 2012 and Bachelor of Science from Virginia Tech in 2008 where he graduated summa cum laude. In 2017, Mark graduated from Evidence in Motion’s Orthopedic Residency program and passed his Orthopedic Specialist Exam. He immediately enrolled in Evidence in Motion’s manual therapy fellowship program which he completed in the fall of 2019.
In addition to owning and operating Onward Richmond, Mark serves as a teaching assistant for the Institute of Clinical Excellence (ICE), where he travels the country teaching how to better manage neck and back pain, as well as advanced manual therapy courses, such as spinal manipulation. Mark has been thoroughly trained through ICE and has a unique treatment style, combining the use of skilled hands-on techniques, as well as progressive exercise, in order to help you achieve your goals and improve your overall well-being. Outside of the clinic, you can find Mark attending live music with his wife Liz and hanging with his dog Remus.
021: Youtube OT/PT: Shoulder Pain Exercises with Andrew Walquist PT, DPT, FAFS, OCS and Chad Burnham DPT, FAFS, CSCS
Have you ever gone to the internet to look for exercises to prescribe for your patients? Have you treated somebody who has come into the clinic and already has a self prescribed home program they got from Youtube? Youtube can be an excellent resource for exercises and information. However, is it appropriate for everyone? Are the exercises addressing the impairments? Steve sits down with previous guests Andrew Walquist and Chad Burnham, as they discuss the most common exercises seen on Youtube for shoulder pain. They give their thoughts on these exercises and suggestions as to what they might do or change.
Where do you start when someone comes in with shoulder pain? Is it really the shoulder causing the pain? In this episode Ryan Holewinski, PT, DPT joins the show to co-host as we sit down and chat with Chad Burnham, DPT, FAFS, CSCS to discuss treating conservative shoulder pain.
One LIMB at a time…..have you ever worked with a patient who is in need of a prosthetic? Today, Shelly Somers, PT, DPT, CHT, ATC, CMTPT, joins the podcast in a great conversation with Jennifer Peterson, MA, PT and Patrick Prigge, CP, FAAOP(D) from Arm Dynamics in Maple Grove, MN. We discuss the process of obtaining a prosthetic for an amputee and the proper steps needed to get him or her measured, fitted and trained with a new prosthetic. Join us as we break down these steps to restore function one limb at a time.
Have you ever treated someone with numbness and tingling and you couldn’t quite figure it out or help them the way you wanted? Have you ever thought about starting your exam proximally? Oftentimes with nerve compression conditions, we see proximal involvement in addition to the distal presentation, which unlocks a whole new realm of treatment possibilities for positive outcomes. Join us on today’s podcast as we learn about the symptoms, clinical examination, and rehabilitation of Thoracic Outlet Syndrome.
Our Guest, Ann Porretto-Loehrke graduated with a BS in PT from Marquette University in 1994 and a post-professional DPT from Drexel University in 2007. She became a CHT in 2002 and earned a manual therapy certification in 2003. Ann has a passion for learning and clinical teaching and has been continuing education instructor for the 16 years. From her manual therapy training, Ann uses a systematic approach to evaluating and treating her patients, which is illustrated in the “Clinical Manual Assessment of the Wrist” published in the 2016 Special Edition on the Wrist in the Journal of Hand Therapy and Chapter 55: “Therapist Management of Compression Neuropathies of the Elbow” in the most recent edition of the Rehabilitation of the Hand and Upper Extremity, published in 2021. She has been practicing at the Hand to Shoulder Center of Wisconsin for the past 20 years.
Got a TWITCH…… Join us as we explore how a taut band trigger point forms, chemical breakdown and what occurs to the band as a muscle is dry needled. Jan Dommerholt, President of Myopain Seminars, interviews with us discussing logistics, principles and current concepts of dry needling. He answers important questions on this hot topic and when this treatment technique is a warranted adjunct and when it’s contraindicated. See remaining show notes for current research articles Jan references in the interview: Ball, A., Perreault, T., Fernández-de-las-Peñas, C., Agnone, M., & Spennato, J. (2022). Ultrasound confirmation of the multiple loci hypothesis of the myofascial trigger point and the diagnostic importance of specificity in the elicitation of the local twitch response. Diagnostics, 12(2), 321. https://doi.org/10.3390/diagnostics12020321 Fernández-de-las-Peñas, C., & Dommerholt, J. (2017). International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: A delphi study. Pain Medicine, 19(1), 142–150. https://doi.org/10.1093/pm/pnx207 Ghannadi, S., Shariat, A., Ansari, N. N., Tavakol, Z., Honarpishe, R., Dommerholt, J., Noormohammadpour, P., & Ingle, L. (2020). The effect of dry needling on lower limb dysfunction in poststroke survivors. Journal of Stroke and Cerebrovascular Diseases, 29(6), 104814. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104814 Khalifeloo, M., Naghdi, S., Ansari, N. N., Dommerholt, J., & Sahraian, M. A. (2021). Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: A case report. Physiotherapy Theory and Practice, 1–7. https://doi.org/10.1080/09593985.2021.1978118 Pourahmadi, M., Dommerholt, J., Fernández-de-Las-Peñas, C., Koes, B. W., Mohseni-Bandpei, M. A., Mansournia, M. A., Delavari, S., Keshtkar, A., & Bahramian, M. (2021). Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: A systematic review and meta-analysis. Physical Therapy, 101(5). https://doi.org/10.1093/ptj/pzab068 Voss, M. R., Donnay, R. L., & Homa, J. K. (2021). The effects of dry needling on the thumb: A case report. Hong Kong Journal of Occupational Therapy, 34(2), 132–136. https://doi.org/10.1177/15691861211043687
Hand to Shoulder Center sits down with Dr. Donald LaLonde from St. Petersburg, Nova Scotia, Canada where he describes the evolution of wide awake, local anesthesia, no tourniquet procedures, specific to flexor tendon repairs. Dr. LaLonde is a current practicing plastic surgeon who continues to develop new research and is an icon speaker internationally. He provides excellent clinical pearls for tendon healing and progression of tendon gliding with use of splinting. Tune in to listen to a great discussion with Dr. LaLonde. (Please excuse our audio on this specific podcast, we did our best during editing, however, Dr. LaLonde is hard to hear at times)
The rule of thumb…many have experienced the uncomfortable sensation of pain at the base of their thumb at some point in life, especially therapists! Let’s learn from Mirka Normand, out of Connecticut, to unpack the multitude of factors that lead to CMC arthritis. Learn how to address it from our evaluation strategies to treatment and splinting options. Mirka Normand graduated with a Bachelor of Science in Occupational Therapy from Laval University in Québec, Canada. She completed a Hand Therapy Fellowship with Baylor College of Medicine and Texas Woman’s University in 1999, in Houston TX and was certified as a hand therapist that same year by the Hand Therapy Certification Commission. She received her Advanced Master’s degree with hand therapy emphasis in 2003 from Texas Woman’s University. She was certified as an orthopedic manual therapist through The International Academy of Orthopedic Medicine-US (IAOM-US) in 2006, and soon after joined their faculty for the creation of a specialty Hand and Upper Extremity Track. Mirka works full time as a clinician for Yale New Haven Health System-L&M Hospital on the eastern coast of Connecticut, and lectures nationally for IAOM-US. She is known through Medbridge with instruction on the wrist. She recently submitted her synthesis for her PhD. And will be defending this in the near future, after many months in the lab and reading research. Congratulations to Mirka on these accomplishments. DeMott, L. (2017). Novel isometric exercises for the dynamic stability programs for thumb carpal metacarpal joint instability. Journal of Hand Therapy, 30, 372-375. http://dx.doi.org/10.1016/j.jht.2016.09.005 Book: Albrecht, Jan OTR/L, CHT (2004). Caring for the Painful Thumb, More Than a Splint. 1st ed. North Mankato, Minn. ISBN: 0-976117-0-X
Lateral elbow pain…..ughhh… the low back pain of the upper extremity. Jim Wagner, OTD, OTR/L, CHT, CPAM, CSCS from upstate New York, sits down with the Hand to Shoulder Center to discuss his approach to the lateral elbow. Jim provides a top down approach from the neck to the hips, how movement patterns from other areas of the body can cause lateral elbow pain. Clinical pearls for evaluation, treatment and splinting techniques discussed. Jim is not only entertaining, but full of energy that will keep you engaged. We promise you will enjoy this great discussion. Click to listen about different techniques to address lateral elbow pain.
Jim Wagner has been practicing over 28 years with clinical experience of the UE in orthopedics. He received his post professional doctorate from Rocky Mountain University of Health in hand therapy. He’s certified in PAMs and is a CSCS. He’s a team leader at Guthrie Hand Center and an adjunct professor at both Keuka and Ithaca College OT programs. He’s been involved in competitive powerlifting and bodybuilding for 35 years, participating in 28 competitions. He’s nationally known for instructing cupping, IASTM, orthotic fabrication, blood flow restriction and kinesiology taping. Jim has spoken at Georgia Hand Society Special Interest Group and many other therapy related venues. He’s published in the practice forum section of the AJOT and serves on the education division of the ASHT. He is listed on the docket to speak in Milwaukee for our very own Milwaukee Hand Experience in May of 2022.
Come take a tour with us, dissecting idiosyncrasies and procedures of the wrist! Dr. Jon Cherney, board certified hand surgeon, and Hand to Shoulder Center’s very own, anatomize wrist surgeries and recovery following. Dr. Cherney is board certified by the American Board of Orthopedic Surgery with a Subspecialty Certification in Surgery of the Hand. He specializes in arthroscopy of the wrist, elbow and shoulder and has special interest in reconstruction of areas affected by rheumatoid arthritis and osteoarthritis, nerve compression syndromes and children’s hand issues. Dr. Cherney is a Wisconsin native. He earned his Bachelor of Science degree and attended Medical School from the University of Wisconsin – Madison. He is a proud Badger fan and represents when he can! Dr. Jon Cherney joined the Hand to Shoulder Center of Wisconsin in 2001. In his spare time, he enjoys fishing, weight training, coaching youth sports, basketball, hunting and playing guitar. Tune in and enjoy the wealth of knowledge that Dr. Jon Cherney brings to the table.
Have you wondered why some of your patients with thumb pain, post-distal radius fracture, or wrist tendinopathy are not improving? You might be missing a huge link of the radial column. In this episode Ann Porretto-Loehrke, PT, DPT, CHT, COMT, CMTPT educates us on the anatomy and biomechanics of the radial column of the wrist.
Ann Porretto-Loehrke graduated with a BS in PT from Marquette University in 1994 and a post-professional DPT from Drexel University in 2007. She became a CHT in 2002 and earned a manual therapy certification in 2003. Ann has a passion for learning and clinical teaching and has been continuing education instructor for the 16 years. From her manual therapy training, Ann uses a systematic approach to evaluating and treating her patients, which is illustrated in the “Clinical Manual Assessment of the Wrist” published in the 2016 Special Edition on the Wrist in the Journal of Hand Therapy and Chapter 55: “Therapist Management of Compression Neuropathies of the Elbow” in the most recent edition of the Rehabilitation of the Hand and Upper Extremity, published in 2021. She has been practicing at the Hand to Shoulder Center of Wisconsin for the past 20 years.
Complex Regional Pain Syndrome (CRPS) can be a tricky beast. Luckily we have Miranda Materi on the podcast today to help us better understand this intimidating condition in order to give our patients the best possible outcome. Miranda received her professional clinical doctorate in occupational therapy from Creighton University in 2006. After practicing hand therapy for five years, she became a certified hand therapist. She has a strong interest in research and development in clinical settings and has participated in many studies. Miranda has served as an adjunct faculty member at the Mayo Clinic and currently is an adjunct faculty member at Northern Arizona University. She is also co-leader of the Hand Therapy Academy, alongside our buddy Josh MacDonald, who we talked with back in episode eight.
In this episode, we dive into everything CRPS: diagnostic types, typical patient demographic, symptoms to look out for, why it’s critical to diagnose and treat early, and unique treatment approaches that are backed in evidence (and require a holistic, mind-body perspective). Miranda has a way of breaking down this complex condition to help clinicians feel educated, empowered, and equipped to treat.
The tenth episode of the Hand to Shoulder Podcast is all about baseball. More specifically, we talk about assessing and treating pitchers. And who’s a better expert on this topic than Dr. Garrett Bullock? Not only is he a Doctor of Physical Therapy, he is also a former collegiate and professional baseball player. Dr. Bullock provides insight on ways to assess the lower extremity as a critical part of our evaluation of elbow or shoulder pain and several clinical pearls for maximizing treatment outcomes for these athletes. He encourages us to explore outside of our traditional assessment tool box, throw a curveball in our treatment plans, and strike out pain and dysfunction for good using a whole-body approach.
Dr. Garrett Bullocks Bio:
Dr. Garrett Bullock is physical therapist, quantitative epidemiologist, and former collegiate and professional baseball player. Dr Bullock is a Clarendon Scholar at the University of Oxford and holds joint appointments within the Nuffield Department of Rheumatology, Musculoskeletal Sciences and the United Kingdom Centre for Sport, Exercise, and Osteoarthritis Research Versus Arthritis. He will begin a faculty position within the Wake Forest School of Medicine beginning in July 2021, leading research in the Wake Forest Biomechanics Pitching lab. Dr Bullock is the cofounder of Aletheia, a sport analytics and data consulting company. Dr Bullock consults with the NFL, MLB, English Institute of Sport, the United States Military, and Functional Movement Systems. Dr Bullock is a recent PhD graduate in clinical epidemiology and medical statistics at the University of Oxford.
Dr Bullock’s research focus is in creating real world clinically applicable research, that has direct application to clinical decisions in sports and orthopedic medicine. His specific research entails big data epidemiology, injury risk and risk mitigation, and life span impact of exercise and sport. He has over 60 publications.
Do you have patients you just cannot seem to get out of pain or explain the reasoning behind their pain? Dr. Chad Cook returns to take a deeper dive into the complex world of pain. In addition to his clinical research, advocating for the therapy profession, and treating patients, Dr. Cook holds a Certificate in Chronic Pain Management from McGill University. In this episode, we discuss pain types – guided by the Pain and Disability Drivers Model – which Dr. Cook helped develop. We dive into each category with Dr. Cook providing clinical examples and interventions for each. You will learn how to determine if your patient is pain adaptive or pain non-adaptive and how to approach these patients in the clinic with more confidence and skill.
The Extensor Tendons. Located on the back of the hand, sometimes referred to as the extensor hood, the extensor mechanism, etc. It can get complicated with the different structures. Listen as Josh MacDonald MS, OTR-L, CHT from Hand Therapy Partners guides you through all you need to know.
Josh is a certified hand therapist (CHT) with extensive experience working directly with hand surgeons to help rehabilitate hand trauma surgery patients. Some of the more common conditions Josh has treated include:
Flexor and extensor tendon injuries Amputation revisions Compartment syndrome Soft tissue trauma and grafting Digit and forearm fractures
Josh began his career specializing in pediatrics focusing on outpatient therapy, neurorehabilitation and pediatric hand therapy. In addition to caring for patients, Josh has started and managed therapy clinics and developed pediatric therapy programs for handwriting training, aquatic therapy, inpatient neurorehabilitation evaluation and inpatient therapeutic outings.
According to Josh, some of the most challenging patients have chronically stiff hands. Josh recently helped one of these patient through her recovery process. After a car accident broke most of the bones in her hand, this patient developed a severely stiff hand and fingers. She worked hard at therapy after surgery, but her progress was slow and tedious. She became understandably frustrated when she did not soon regain full motion in her injured hand. But after months of hard work, this patient was able to return to work and independent driving and self-care tasks. Not every patient can regain 100% of his or her hand functions after a severe injury, but Josh works with each patient to help them reach their highest potential.
Josh is fluent in conversational Spanish and is constantly pursuing professional education opportunities. He regularly participates in national conferences sponsored by the American Association for Hand Surgery, American Society for Hand Therapy, American Society for Surgery of the Hand, Indiana Hand Care and the Philadelphia Hand Foundation. Josh is very active in the local Crossfit community and has multiple Crossfit certifications. He also coaches children, adults and competitors.
Josh received his Masters in Occupational Therapy from Grand Valley State University in 2001 and his Hand Therapy certification in 2015.
Have you ever wondered where and when hand therapy was born? Well Terri Skirven, OTR/L, CHT walks us through the seeds of when, where and how hand therapy blossomed. She outlines the foundation of the ASHT Board and Conference, Philadelphia Hand Conference and how the iconic CHT (Certified Hand Therapy Exam) was instituted, as well as how to become a speaker for continuing education conferences. Terri is well known for her commitment as a co-author of Editions 5, 6 and 7 (newest) of Rehab of Hand, and how these hand therapy bibles have evolved over time. Join us as we interview Terri as she discusses the milestones of her career and walks us through the history of hand therapy.
The flexor tendon system of the hand is what we use to interact with our environment. Dr. Rebecca Neiduski, PhD,OTR/L, CHT, from Elon University, dissects tendon zones, strand repairs and progression of therapy after a flexor tendon repair. Rebecca received a Bachelor of Arts in Kinesiology and Leisure Studies from Purdue University; a Master of Science in Occupational Therapy from Washington University in St. Louis, and a PhD in Educational Foundations from Saint Louis University. Rebecca practiced as a hand therapist prior to her to move Academia. She is currently the Dean of School of Health Sciences at Elon University in North Carolina. Please join us as we learn the recovery of a flexor tendon post trauma through words and research of Dr. Neiduski.
Have you ever considered economics, education, neighborhood, and lifestyle choices of each of your patient’s when treating them and how this may impact their treatment? Today we are joined by Dr. Zachary D. Rethorn to educate us on this topic. Dr. Zachary D. Rethorn is a board-certified orthopedic physical therapist and certified health coach with clinical and research expertise in musculoskeletal pain conditions, physical activity, and health promotion. He earned his undergraduate degree in Exercise Science from Belmont University followed by his DPT degree from the University of Tennessee at Chattanooga. Dr. Rethorn has completed a residency in orthopedic physical therapy through Benchmark Rehab Institute and is a PhD candidate in health promotion and wellness at Rocky Mountain University of Health Professions where his research focuses on how health professionals promote physical activity with their patients. He completed a faculty development resident at Duke University in the Doctor of Physical Therapy Division and is the owner of Rethorn Physical Therapy and Wellness, a digital physical therapy practice. He has presented at national and international conferences on topics related to orthopedic physical therapy, social determinants of health, and health promotion.
Below are links Dr. Rethorn referred to in the podcast:
Here is what Dr. Rethorn uses as his intake when treating his patients: https://healthleadsusa.org/resources/the-health-leads-screening-toolkit/
Comparisons on Social Screening tools: https://sirenetwork.ucsf.edu/SocialNeedsScreeningToolComparisonTable
Some Data sources to get to know your community better:
The Triangular Fibrocartilage Complex (TFCC) can be a complicated and intimidating structure. Theresa Parry OTR, CHT, COMT joins us to break it down with an insightful discussion of the structures, the role, rehabilitation, and orthotic selection when treating someone with TFCC involvement. If you are interested in learning from Theresa she teaches continuing education courses for the International Academy of Orthopedic Medicine and has a course on medbridgeeducation.com “Treatment of Ulnar Wrist Sided Pain” that will be released soon!
003: Navigating Rotator Cuff Repairs with Paul Gagliano, PT, DPT and Daniel Miriovsky, PT, DPT, OCS, FAFS, ATC, FGC
In this episode we are joined By Dan Miriovsky, PT, DPT, OCS, FAFS, ATC, FGC and Paul Gagliano, PT, DPT for a discussion about rotator cuff protocols. They add deep educational insights about how to manage patients with very different protocols, early ROM vs immobilization, and how to look beyond the glenohumeral joint in all phases of recovery.
Dr. Chad Cook is a clinical researcher out of Duke University, a physical therapist, and a profession advocate with a history of clinical care excellence and service. His passions include refining and improving the patient examination process and validating tools used in day-to-day physical therapist practice. As you will hear, he has over 300 publications and is a wealth of knowledge in the areas of manual therapy, pain modulation, and clinical research. In this episode, we talk about the role of both the clinician and patient in manual therapy services, pain management in relation to therapy outcomes, intervention selection, and patient buy-in, use of modalities for pain management, the current landscape of the student experience in a COVID-19 world, and some insight to his current studies, which we find fascinating and can’t wait to get our hands on when the results are published.
Welcome to the first ever episode of the Hand to Shoulder Podcast! We are excited to kick things off with an interview that will leave you motivated to change your clinical approach with your very next patient and likely even try new things with patients who come to mind as you listen. Our guest, Andrew Walquist, is a PT with an impressive resume and a perspective on rehab that is fresh and effective.
Episode 16: I’m Wide Awake – Flexor Tendons with Dr. Donald Lalonde
Video: 8 Tips to consistently get good results in clean cut flexor tendon repairs in cooperative patients.