A Closer Look At A Valuable Diagnostic Tool For Focal Nerve Entrapment

“It’s really dark in here.”

“Just hold on a second and it won’t be,” Chamberlain replied.

Boom! The intense flash of blue light from at least 20 computer screens stunned me for a couple of seconds while my eyes tried to adjust. 

“Look at this,” he commanded. “It is right here.”

I peered down at all of the columns of data trying to make sense out of it. “Oh yeah, I see it.”

“So, it appears that your colleagues—how many of them are there?”

I sighed deeply. “About 18,000 to 19,000 who are currently in practice, maybe more.”

“Alrighty then and 541 of them took time to read about the ‘The Phoenix Sign’?” (https://youtu.be/CrPDp4fCDTI ) He paused while doing some quick mental calculations in his head. “Well that is 0.02924 percent and of that, 55 actually took the 3:21 to view the video?”

“Well,” I corrected him, “it appears by this that only about 50 percent made it 1:42 through the video. Who knows? If you were under water, I guess 3:21 would be a long time but that is hardly enough time to take a few deep breaths and enjoy the moment.”

As the illumination gradually increased in the computer lab, we walked over to the other side of the room by the conference table. Chamberlain hesitated to sit down, walked back and forth for a few minutes, and then stopped. “I don’t think they get the message. For God’s sake, you’ve given your colleagues an unbelievable diagnostic tool—something that is a real game changer for a patient with drop foot—and they can’t take three minutes and 21 seconds to put a virtual nuclear weapon in their diagnostic armamentarium?”

Chamberlain was into “Big Data” now and between running epidemiological analyses and Bitcoin mining, he was consuming more electricity than scotch for the first time in his life. He ambled back over to the bank of computers and started punching keys in a staccato manner.

After a few minutes of number crunching, he beckoned me over. “If you would have put the word fungus in the title of the video, you would have exponentially increased the number of reads and the number of views from those reads by about 35 percent according to my calculations.” 

He then went into one of his elegant and erudite soliloquies, and I just listened. “You have to embrace redundancy if you want anyone to listen and then repeat it some more. But you have to do it in a special way. According to some in medical education, there are four cornerstones to drive home your point:

1. Focus the message and develop a great hook.
2. Organize the material into no more than three points.
3. Promote knowledge transfer. Make it easy and applicable.
4. Create a connection to the message so they will remember it.

“So how can you do that?” he pointedly asked.

“Okay, let me see if I can get down to it,” I stuttered. “The message is that if you have a patient with a drop foot, weakness or difficulty in dorsiflexion or, for example, continued pain long after an ankle sprain, there might be an entrapment of the common fibular (peroneal) nerve at the fibular neck. It may not have a provocation sign and rarely has a Tinel’s sign. If that is the case, do an infiltration like I show in the video and see what happens.

“Now for the organization and three points part of it, think about the fact that this is not that hard to diagnose. If patients have a positive ‘Phoenix Sign,’ then you can pretty well rest assured that there is a focal entrapment, and decompression of that nerve will likely improve your patients’ condition, provided you get them before 12 to 13 months after the injury.

“There are the three simple points. Don’t overthink it! Now, I have just transferred some knowledge that is hugely applicable. You can diagnose this nerve condition with relative ease. Sure, it will take some skill in developing the technique, but wow—what power you will have in the clinic. As far as the connection aspect goes, patients will instantly give you so much positive feedback. Most of the time, patients have been to multiple practitioners who have no idea of what is going on and you can now tell them! Believe me, that will create a connection.”

“Now that is getting after it,” my esteemed mixologist agreed. “Tell your colleagues that if they really watch the video and implement it into the practice, there is a big carrot for them.”

I chuckled. “By carrot, do you mean something related to a CPT?”