Physical Examination 212: Clinical Pearls in Uncommon Cases

Four complete cases from a sports chiropractic practice, each taken from history to outcome: a competitive pole dancer with chronic bilateral proximal hamstring strains (palpation, hip range of motion, straight leg raise, Kemp's, Yeoman's and Ely's tests, radiographs, and a staged soft tissue and strengthening program); a 54-year-old man with chronic low back pain whose report of findings surfaced urinary and sexual symptoms, leading to PSA testing, MRI, biopsy and a prostate cancer diagnosis, with the American Urological Association screening guidelines, Gleason scoring and treatment options; a 40-year-old woman with post-traumatic adhesive capsulitis after surgical repair of a shoulder dislocation and fracture, with the phases, evaluation and rules of treatment for a frozen shoulder; and a rear-end collision patient with whiplash and concussion, with the collision history, the ACE form, cranial nerve testing, the Balance Error Scoring System, CT versus MRI, and nutritional support. The course opens with the history and neurovascular screen that apply to every case.

Dennis O'Hara, DC, DACBSP — sports medicine chiropractor, Diplomate of the American Chiropractic Board of Sports Physicians, ACBSP concussion certified, former chiropractor for D.C. United and MMA ringside physician — teaches the 2-hour course. It is written for Doctors of Chiropractic who want to see how a thorough examination plays out on real patients: what to ask, what to palpate and test, when to image, when to treat, and when a musculoskeletal complaint is the surface of something that needs a medical referral.

When the history and examination point past the spine, which is the lesson of the course's second case. A 54-year-old man came in with chronic low back pain that behaved mechanically — dull, worse rising from a chair, with the limited ranges and positive Kemp's test you would expect — and radiographs showed only mild degeneration at L4–L5 and L5–S1. What changed the picture was the conversation at the report of findings: he had not had a physical or bloodwork in over a year, could not recall a PSA test, and mentioned urinary problems and erectile dysfunction. He was referred for medical evaluation and PSA testing while chiropractic care continued; the PSA came back elevated, MRI located lesions in both lobes, and biopsy confirmed prostate cancer that was treated successfully with radiation. The pearl is that the examination includes asking about screening and about symptoms outside the chief complaint, and that referral and chiropractic care run in parallel rather than one replacing the other. The course lays out the American Urological Association guidelines on who should be screened, how often, and what follows an elevated PSA.

Physical Examination 212 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. O'Hara's regional courses — Physical Examination 202: Neck and Upper Extremities, 203: Lumbar Spine and Lower Extremity and 206: Knee and Lower Leg — teach the examinations the four cases apply, and any three of the four courses are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). Each case opens onto one of his longer treatments: Case Studies & Clinical Pearls 220: Soft Tissue Injuries, Sports Injuries 268: Shoulder Conditions, Sports Injuries 258: Concussion Update and Whiplash 207: Personal Injury Case Management. New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.