Review - Clinical XXX (Orthopedics)

[Intro: 105 BPM. A scratching wah-wah guitar opens the track. The drummer counts in with four hi-hat clicks, and the full funk band explodes into a massive, bouncing groove. The Funk Master grabs the mic.] (Funk Master) Get on up! We're talking bones and joints today, baby! Listen to the groove... hit me! Fall onto an outstretched hand “Colles, scaphoid fracture”! [Verse 1: The bassline gets incredibly funky, popping and slapping. The Funk Master rides the pocket perfectly.] (Funk Master) Scaphoid fractures; pain and swelling at the anatomic snuffbox, yeah! Scaphoid compression test. X ray. Treat with thumb spica, make it right! Surgery if displacement above 1mm in the night! Smith; fall onto a flexed wrist. Distal radius fx with volar angulation, get the gist! Colles and Smith; closed reduction and cast immobilization! [Pre-Chorus: The horns play a rising, syncopated line. The backing choir steps to the mic.] (Funk Choir) Tarsal tunnel syndrome... (Funk Master) Sole paresthesia, foot dorsiflexion and eversion pain! [Chorus / The Shoulder Shake: The beat drops into a wide, open funk swing. The Funk Master preaches to the crowd.] (Funk Master) Subacromial impingement syndrome; anterior shoulder pain with overhead activities or on internal rotation, pain with sleeping on the shoulder, feel the sensation! Hawkins or Neer impingement sign, draw the line! Four radiographic views, M.R./U.S.G.! Conservative approach, setting you free! [Verse 2: The wah-wah guitar takes the lead. The delivery is rhythmic and staccato.] (Funk Master) Rotator Cuff Tears ‘mostly supraspinatus’; Difficulty lifting the arm, limited active R.O.M., impingement symptoms. X ray, M.R.! Conservative approach, be a star! Shoulder Dislocation; anterior; abducted and externally rotated! If posterior, holds the shoulder, internally rotated, well stated! [Bridge / The Frozen Groove: The music strips back to just a glowing electric piano and the bass. The Funk Master speaks softly but with intensity.] (Funk Master) Adhesive capsulitis; extremely painful shoulder, limited passive and active R.O.M., baby. Self-limiting but very debilitating, 40-65 years. Usually a clinical diagnosis. N.S.A.I.D.s, physical therapy, intra-articular or oral steroids! [Verse 3: The heavy funk beat crashes back in. The horns blast a powerful melody.] (Funk Master) Low Back Pain. Alarm symptoms; weight loss, failure to improve with treatment, severe pain above 6 weeks, and night or rest pain! Urinary/fecal incontinence, saddle anesthesia, bilateral lower extremity weakness; cauda equina syndrome, don't complain! Spinal Stenosis by O.A./disc problems; pain worse with back extension, standing! Bilateral leg symptoms relieved by sitting “neurogenic claudication”, understanding! M.R./C.T.! Conservative treatment! [Chorus 2 / The Spine Grind: The Choir harmonizes while the Funk Master ad-libs.] (Funk Master) Herniation ‘sharper, intense pain’, stenosis ‘chronic, gradual’! Lumbar Disc Herniation; pain with back flexion, sciatica! M.R.I.! Bed rest for acute exacerbation, modified activities; N.S.A.I.D.s, physical therapy! [Verse 4: The drummer plays a tight solo under the vocals. The rhythm is infectious.] (Funk Master) Carpal tunnel syndrome, numbness, especially at night, waking the patient! Phalen, Tinel and Durkan test, be patient! Activity modification, splinted, physical therapy and electrophysical modalities. Oral steroids or N.S.A.I.D.s! Steroid injection! Surgery! [Outro / The Grand Funk Finale: The entire band plays at maximum volume. The Funk Master belts out the final hand conditions like a soul legend closing a show.] (Funk Master) Dupuytren Contracture; white men above 50! Associated with alcohol, cirrhosis, fibrosing disorders, looking nifty! Nodular or cord-like thickening of one or both hands, mostly fourth-fifth fingers! Generally, well tolerated. Corticosteroids, physical therapies, surgery, it lingers! De Quervain Tenosynovitis; thickening and myxoid degeneration of the A.P.L./E.P.B. tendon! Radial-sided wrist pain worsened by thumb and wrist motion! Positive Finkelstein! Splinting, N.S.A.I.D., and corticosteroid injections! (Choir) ...corticosteroid injections! [Ending: A massive, synchronized funk chord hits. The drummer crashes the cymbals, the bass plays one final, booming slap-pop, and the horns scream out a high note. Total silence.]