Derek Petit

Papa & husband 🇨🇦 Physiatrist interested in everything MSK & EMG💪🩺 Deteriorating athlete & Fantasy sports junkie⛹‍♂🏈 Secret Sci-fi nerd🧬

[Derek Petit @PetitDerek]

@NickHoopes_ I really hate clamshells. Most people cheat with their hip flexors, never actually works for the patients I see. Much prefer sit to stand and step ups

[Derek Petit @PetitDerek]

@DrMarwanAl_D Before neck I would want EMG. I was actually thinking wrist/hand to assess the tendon

[Derek Petit @PetitDerek]

@DrMarwanAl_D If the 3rd digit FDP is intact, it would push me less towards nerve - but even then you could theoretically get fascicular sparing. Wonder if an MRI would help at all

[Derek Petit @PetitDerek]

@DrMarwanAl_D Seems too isolated for a TIA - I would check FPL and wrist pronation, both innervated by AIN as well. Could be mononeuritis multiplex, neuralgic amyotrophy, C8 radic. Great case to refer for EMG

[Derek Petit @PetitDerek]

@ZachBailowitzMD Holy

[Derek Petit @PetitDerek]

@DrJN_SportsMed I’m wondering, but in your experience - does steroid add much here? I suppose it theoretically makes sense if there is muscle “edema/inflammation”, but I’m curious if LA alone would yield similar results

[Derek Petit @PetitDerek]

@JameyEisenberg Big fan of your work Jamey, thought I’d leave this here, never had a loss on a kneel before

[Derek Petit @PetitDerek]

@DrJN_SportsMed Does he have an Achilles reflex? The pain with coughing and pretty convincing disc bulge makes me think the radiculopathy is #1 here

[Derek Petit @PetitDerek]

@DrJN_SportsMed Lateral head has a bit of L5, medial head better S1 “proper” muscle - could explain US. Completely agree re: fatty infiltration and recovery. The horse has left the barn at that point, recovery will be minimal, if at all, in this case. Axonal recovery occurs for 12-18 months

[Derek Petit @PetitDerek]

@TTRAmyloid @DrMarwanAl_D @SportsDocSkye True, the clinical presentation does. EMG is still is key, because if picked up early and severe denervation/no recovery within 3-4 months, can discuss nerve transfer surgery, which according to our center has better outcomes when done within 6 months

[Derek Petit @PetitDerek]

@DrMarwanAl_D @FemboyElonMusk Truthfully in an acute pain presentation, unlikely there is a mass there - in my centre we don’t always image these if the clinical fits. You can see “hourglass” nerve bundles on high resolution, but it does not add much

[Derek Petit @PetitDerek]

@DrMarwanAl_D @RyanVrindtenDPT @MBeasleyMD About 50% of these patients have ongoing pain after 1 year - big reason is the scapula-stabilizing musculature is weak. So GHJ subluxation, fatiguability, trigger points… tough to manage in chronic setting, in PM&R we discuss PT/bracing and even tendon transfers sometimes

[Derek Petit @PetitDerek]

@physionerdAU @DrMarwanAl_D @AdamMeakins Absolutely not. In fact I’d venture most young males. I have seen 5-6 of these in EMG clinic last 2 years, including a 19 year-old perfectly healthy male with no correlation whatsoever to a recent vaccine

[Derek Petit @PetitDerek]

@NickIlic_Physio Don’t disagree with the Spondys - but in practice, I see way more the other way. It’s generally overcalled, and a common site of referred pain. “Please inject left SIJ”, only it’s glute tendinopathy, LSS, hip OA, hamstring tendinopathy, etc…

[Derek Petit @PetitDerek]

@UBC_PMR @Paris2024 That’s awesome! Congrats Julia 🥳

[Derek Petit @PetitDerek]

@DocOfSports @tomgoom @DrJN_SportsMed @TheHipPhysio @TaylorAlanJ I generally feel like an isolated muscle injury (piriformis, ischiofemoral impingement, IO) has another primary explanation - training error, increased load, referred from another source. I really want to make sure I’m not missing a 2ndary cause for their “piriformis is tight”

[Derek Petit @PetitDerek]

@DocOfSports @tomgoom @DrJN_SportsMed @TheHipPhysio @TaylorAlanJ I like to have a functional approach - i.e. biomechanics patterns. Helps identify a tendinopathy and more. Otherwise I go by risk factors:
- Women, pregnancies, hypermobility: SI joint/pelvic instability
- Vascular risk fx: PAD
- Young: AxSpa
- Old: Osteoporotic fracture

[Derek Petit @PetitDerek]

@DocOfSports @tomgoom @DrJN_SportsMed @TheHipPhysio @TaylorAlanJ It’s surprising how radics can be hard to pick up sometimes, especially in equivocal imaging.

Hard to expand with character limit, but my approach is like yours with hip + spine (including facets) 1st. I need to be convinced it has appropriately been ruled out or assessed

[Derek Petit @PetitDerek]

@DocOfSports @tomgoom @DrJN_SportsMed @TheHipPhysio @TaylorAlanJ One of the highest yield diagnoses I’ve found in these is an L5/S1 radiculopathy. I always do a careful Neuro exam in glute pain NYD and will not hesitate to image the spine or order EMG. A subset of patients have sensory/demyelinating radics which makes it even more challenging

[Derek Petit @PetitDerek]

@BluesteinLinda @dianajovin Many examples, but ex. having an approach to cervico-cranial instability. Management of POTS. Pathophysiology of MCAS and mimics. Pain concepts as they apply specifically to HSD patients. I could go on! Made me confident in my messaging and gave me more tools to share with them