Charlie Clements
@ClementsCharl96
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First Contact Physiotherapist | Instagram 📸 THETHREADPHYSIO | Passionate about CPD 🧠
Bristol, England
Joined April 2017
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Pinned Tweet
I’m delighted to collab with
@CorKinetic
on delivering a 1 day course ‘Recognising Red Flags 🚩’ later this year!
This will include,
✅ F2F with practical exam tips
✅ Real life case studies
✅ ⬆️ confidence w decision-making
For further info;
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1) A brief 🧵looking at common peroneal neuropathy (CPN) & how to differentiate from more proximal lesions, plexopathies or radiculopathies.
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1) A short 🧵looking at some key points for Lumbar Spinal Stenosis (LSS)
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An infographic with a brief look at *some* of the key features for different causes of leg pain which might coexist with back pain 🧠
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1) A 🧵 overviewing Femoroacetabular Impingement of the Hip
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Another great infographic made by
@ShoulderGeek1
&
@clinicaledge
I particularly like the cluster of tests to help rule out C-spine involvement. Another Q I ask is if they can lie comfortably on the shoulder that is hurting it’s unlikely to be true shoulder pain
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1) A thread looking at Adductor Related Groin Pain (ARGP)
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1) A brief look at some of the clinical features for differentials of hip pain
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Really like this infographic from
@function2fitnes
on DGS, an extra-spinal cause of sciatic nerve pain.
DGS is thought to the culprit in up to 6-17% of cases within primary care (Hopayian et al., 2019), so it is well worth keeping it on your radar!
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An infographic looking at some of the key clinical features of common hip differentials 💡
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1) A very simple way of trying to differentiate between peripheral nerve palsies in the upper limb 💡
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A v brief overview on a v complex topic so go easy on me Twitter gurus.
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1) A short 🧵 looking at clinical clues to help differentiate between C8 radiculopathies vs ulna nerve entrapments in their various locations
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1) A 🧵 looking at Morton’s Neuroma (MN).
MN is considered an entrapment degenerative neuropathy affecting the interdigital nerve as it lies beneath the intermetatarsal ligament.
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1) A 🧵 looking at spinal metastatic cancer. A red flag pathology to be mindful of, especially when treating spinal pt’s 🚩
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1) A 🧵 providing a whistle stop tour of Frozen Shoulder (FS)
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1) A thread 🧵looking at triangular fibro cartilage complex (TFCC) injuries, a common culprit for ulna-sided wrist pain
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1) A 🧵 thread looking at greater trochanteric pain syndrome (GTPS).
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1) *With pt consent* in clinic today; suspected distal biceps tendon rupture 4/7 after attempting to move a heavy piece of gym equipment alone. Current Hx of anabolic steroid use. So thought I’d make a 🧵 out of it
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1) A 🧵 looking at avascular necrosis of the femoral head (AVNFH). A serious condition to be mindful of when assessing hips
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An infographic providing a brief overview of some of the clinical features of a few hip pathologies
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1) A brief 🧵on Avulsion Fractures
Always keep on the radar 🚨 in any adolescent presenting with acute pelvic pain OR recalcitrant Sx which are not responding to conservative efforts
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1) A 🧵 looking at lumbar radicular pain & radiculopathy
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Useful diagram from Millar et al (2022)
Overview of some features associated with more common shoulder pathologies to help aid your clinical reasoning
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1) A brief dive into Lumbar Spinal Stenosis (LSS), looking at; a) what happens, b) who it tends to affect, c) it’s clinical features & d) how we can potentially treat it
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Cheat sheet for Hip Pain 💡
Some useful reminders to help differentiate between common conditions. As always, not gold standard and there can be overlap
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1) A series of slides compiled providing a brief look at; a) disc anatomy & injury and b) conservative vs surgical options
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Useful infographic looking at the management of Carpal Tunnel
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1) Short of time and want to quickly examine for a neuropathy of the a) median, b) radial or c) ulnar nerves?
Try the Kumar’s Sign
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An excellent infographic by the BMJ which provides a brief insight towards some key features to help aid your management of shoulder pathologies, especially in Primary Care.
*Just remember it’s never that black or white* 😉
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1) A 🧵 looking at Quadrilateral Space Syndrome (QSS). A rarer cause of shoulder pain
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1) A 🧵 looking at Cervical Artery Dissection (CAD). A vascular pathology which is a differential for cervical pain that requires urgent consideration
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Nice resource from the team
@PhysioNetwork
illustrating some objective features of differentials for Frozen Shoulder ❄️💪
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1) 🧵
*With consent*
Nice e.g of favourable natural history of lumbar radiculopathic symptoms.
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Deep Gluteal Syndrome 💡
An interesting condition which needs more research investigating it. One that potentially is not considered / misdiagnosed when looking at buttock/leg pain & neuropathic leg symptoms.
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1) A 🧵 looking at meniscal root tears (MRT) of the knee.
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1) A 🧵 looking at Vertebral Compression Fractures (VCF).
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1) Intermittent claudication is something often encountered in practice, especially in our older demographic of patients. But how can we differentiate between neurogenic vs vascular? Or if the two occur concomitantly⁉️
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A look at some papers I have found useful for spinal conditions (by no means an exhaustive list)
Keen to hear of others favourites
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Infographic from a previous post looking at potential ways to different between a C8 radiculopathy vs mononeuropathy / entrapment of the ulnar nerve
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Some of the differentials to consider for groin pain accompanied by a few 🔑 clinical tests to help distinguish
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An infographic with a brief look at some alternative causes of leg pain to keep in mind with your differential diagnosis 💡
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1) With consent ✅🧵
Nice e.g. of a sustained BL clonus. Referral - ‘knee pain’. 3/12 Hx worsening leg Sx, balance + falls
▪️8/52 B/B incontinence + loose stools
▪️PmHx - IVDU, ETOH ++, Colon Ca
▪️x1 fall due to ETOH & head trauma resulted in a CT head @ A/E - NAD
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1) A very quick look 👀 at the stages of Cauda Equina Syndrome (CES)
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1) A whistle stop tour looking at the prognosis of some of the common spinal conditions we encounter.
*Note this will vary considerably & is dependent on so many factors*
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1) A brief 🧵 looking at Pancoast tumours which are a rare type of lung Ca (3-5% cases). It is a 🚩 which clinicians should have awareness of when assessing upper extremity injuries.
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Nice succinct review looking at the epidemiology, risk factors, features and considerations for onwards referral for disc herniations ⬇️
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Infographic with a brief look at Cervicogenic Headaches
If you want to read more around the treatment, check out a blog I wrote for
@PhysioNetwork
below ⬇️
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1) A brief look at the Straight Leg Raise, or the Lasegues sign. Named after Charles Lasegue from the 1800’s
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Inspired by
@JLTHphysio
Thought I’d have a stab at how I go about explaining common back pain themes. This made me realise I’m actually pretty lowsy at doing this with a lot of room to improve. Apologies if they aren’t your ☕️
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1) A thread looking at the rather weird and wonderful, Meralgia Paraesthetica (MN)
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1) Keeping with the recent change in NICE guidelines & overall buzz on socials. I have compiled some slides looking at prevalence, features of hip OA & some of the differentials
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1) A return of the 🧵, this time looking at Cervical Radiculopathy (CR)
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An infographic briefly looking at Spine-Related Leg Pain
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1) A 🧵 looking at EPL ruptures following distal radius fractures (DRF).
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1) Some early stage isometric loading for Proximal Hamstring Tendinopathy.
Reducing hip flexion angles helps attenuate the amount of compression load through the tendon and these are some useful exercises to include early doors
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1) Attempting to be more active on Twitter… so thought I’d start with a short thread on all things ulnar nerve related (go easy on me Twitter gurus)
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1) This is a very useful paper which looks at the different stages of CES (disclaimer, it’s never that black & white).
They define it as; a clinical Dx with disorder of 1 or more S2-5 nerve roots with 1 or > Sx;
- B/B dysfunction
- Saddle anaesthesia
- Sexual dysfunction
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An oldie but goldie
Some outdated, but for the most part excellent info looking at the clinical assessment of the hip
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Great infographic looking at PADS from the Morley et al., (2018) study.
Full access to the paper I think should be from ⬇️
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Cervicogenic headache (CGH) is a rarer form of somatic referred pain from the upper Cx spine which can occur insidiously in 30-40yrs (1-2.5%) but is more common post-trauma (WAD - 53%) whereby 70% of cases arise from theC2/3 facet joints (Bogduk & Govind, 09).
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1) A brief look at BSI’s & what are some of their clinical features?
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1) Short thread on why foam rolling (FR) the Iliotibial band (ITB) for ITB syndrome makes absolutely zero sense
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Great overview on screening for serious pathology. Important irrespective of what setting you work in ‼️
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1) *With consent*, another example of rare but there pathology. HPC; 5/7 twisting mechanism of knee on a lorry, acute pain & ++ ⬇️ function so I r/v’ed urgent F2F. PmHx; hyperlipidaemia & T2DM.
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If you don’t like listening to me waffle on. Here is an Infographic with some of the key features from yesterdays 🧵
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Useful illustration outlining Carpal Tunnel Syndrome from the Currie et al., (2022) paper…
Clinical Test values were;
Durkan - SP 83% & SN 64%
Phalens - SP 73% & SN 68%
Tinels - SP 77% & SN 50%
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Short & sweet infographic looking at Common Peroneal Neuropathy 🧠
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1) With consent, a nice example of an advanced presentation of Dupuytrens Disease (DD).
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1) A 🧵 looking at plantar plate injuries (PPI). *If you’re squeamish of feet this post might not be your ☕️*
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1) A 🧵 looking at Spontaneous Osteonecrosis of the Knee (SONK).
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1) What are some clinical tests we can do to differentiate LSS or PAD’s?💡
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1) A series of slides (more patient friendly) looking briefly at the diagnostic triage of low back pain 💡
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1) A whistle stop tour of muscle cramps. How can we tell if they are idiopathic vs something more systemic?
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Another useful illustration looking at the features, objective tests and treatment options for OA of the 1st CMCJ from Currie et al., (2022).
It’s thought approx 20% will require treatment for symptoms, but worth knowing nonetheless
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Infographic illustrating some key points when suspicious of MTSS vs stress #
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1) A 🧵 looking at Pudendal Neuralgia / nerve entrapment
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1) MTSS or tibial stress #. What’s the difference and how can I spot it?
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A brief look at Osteoporotic vertebral compression fractures
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1) A brief look at some of the clinical features & tests we can consider to increase our suspicion of Csp Radiculopathy 💡
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I had the pleasure of writing this blog on Spinal 🚩’s for
@ClinicianBetter
Check it out and let me know your thoughts ⬇️
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An infographic looking at some clinical features which can help differentiate between a C7 radiculopathy vs radial nerve mononeuropathy.
Also some quick tests to look at if suspicious of posterior interosseous involvement. 🧠
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1) A brief look at some of the data surrounding exercise selection & glute activation via EMG (disclaimer - take the results with a pinch of salt 🧂)
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Nice review looking at CTS, de Quervains & thumb OA.
Especially useful for those in primary care as a little refresher
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1) Back with some useful articles related to all things spine & leg pain 🧠
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1) A 🧵 looking at Subchondral Insufficiency Fractures of the Knee (SIFK).
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Useful infographic by the BMJ highlighting some of the features of Axial SpA and PsA coupled with the management and referral criteria.
An area I certainly need to revise more
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1) A 🧵 looking peripheral arterial disease (PAD’s). An important differential to consider for those presenting with leg pain
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1) *With patient consent*
Interesting one today and first time I’ve encountered. Suspected radial nerve (or Saturday night) palsy. Intoxicated over the weekend, woke up with mild wrist drop and inability to extend 3rd-5th digits at the MCPJ. 🧵
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‘Approximately 683kg needed to stretch the glenohumeral joint capsule?!’ 🤯 really liked that recent podcast
@JeremyLewisPT
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1) Hot off the press! SLR investigating the effectiveness of conservative Rx for treating LSS patients with neurogenic claudication (NC). LSS is the most common spinal complaint for adults seeking operative Mx. Yet almost all will require a period of non-op Rx beforehand.
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Nice to see this recent paper further supporting that OKC exercise (even within the first 4/52) had no influence on knee laxity or adverse effects to the graft (irrespective of what type) at short and long-term F/U post ACLR
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Infographic looking at some of the key features for all things Cervical Radiculopathy.
Something that can be a real pain in the neck….
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