S: 68 year old female presenting with neck pain. She has had a history of recurring episodes of neck pain throughout her life but have been self resolving. She has not required any management until this most recent episode lasting 4 months. She has no relevant past medical history or any medical conditions. The neck pain has been affecting her range of motion looking behind her right shoulder while checking her blind spot, looking up, and she is unable to roll over in bed without sitting upright first. She described her neck pain as a constant ache varying between a 3-4/10 pain.
T: perform a full subjective, objective, and appropriate treatment.
A: I took the relevant subjective history and completed a full objective assessment. I was able to establish that C3/4 was the level producing her pain and was limited into extension and right rotation. I then performed a passive accessory technique to improve right rotation and extension.
R: On reassessment of her active range of motion, there was a significant improvement in the range into right sided rotation. The treatment did not have much effect on pain which was to be expected as the technique was into the provocative direction.
E: I think I chose the appropriate treatment technique although provocative to use for this patient. I was able to find the level reproducing the pain and restricting the range of movement. I do think that my assessment technique for motion palpation needs improvement as I am unsure at times how to assess what I am palpating.
S: I asked my supervisor to perform a motion palpation on the patient as well and then discussed with him before I continued on to a treatment. This way, I was able to compare the findings and see if my assessment was accurate. I also discussed the most appropriate technique before choosing it. I found it easier to brainstorm ideas with my supervisor first and then perform them.
Sunday, July 17, 2011
Sunday, July 3, 2011
Week 1
S: 22 year old female presenting with a three month history of thoracic spine pain. The patient has a history of lower back pain, and was currently unemployed as a result. The presentation consisted of constant thoracic spine pain, pain with coughing, and night pain. The patient has no other relevant past medical history.
T: Perform a subjective, objective and appropriate treatment.
A: After taking the subjective history, there were obvious red flags. I did not wish to proceed further with any objective examination or treatment as I did not feel it was appropriate. Instead, I advised the patient to go back to her GP and seek medical advice on the situation and suggested a scan may be appropriate at the doctor's discretion.
R: The patient agreed to my advice. I wrote a letter to the patient's doctor with the subjective examination findings and the suggestion that further investigation may be appropriate. I am unsure as to the result of these at the current time.
E: I was quite nervous once hearing the subjective history, as this was the first time I had encountered 'red flags'. I also did not want to appear as though there was major concern and I think I kept proffessional during the session. I feel I expressed my concern for further investigation in a calm proffessional manner, and not to worry the patient.
S: I seeked advice from my supervisor following the subjective, although he left it to my discretion. I told him I would refer the patient back to the GP and he agreed that was the appropriate decision. He did ask me to complete an objective examination, although it would be limited.
T: Perform a subjective, objective and appropriate treatment.
A: After taking the subjective history, there were obvious red flags. I did not wish to proceed further with any objective examination or treatment as I did not feel it was appropriate. Instead, I advised the patient to go back to her GP and seek medical advice on the situation and suggested a scan may be appropriate at the doctor's discretion.
R: The patient agreed to my advice. I wrote a letter to the patient's doctor with the subjective examination findings and the suggestion that further investigation may be appropriate. I am unsure as to the result of these at the current time.
E: I was quite nervous once hearing the subjective history, as this was the first time I had encountered 'red flags'. I also did not want to appear as though there was major concern and I think I kept proffessional during the session. I feel I expressed my concern for further investigation in a calm proffessional manner, and not to worry the patient.
S: I seeked advice from my supervisor following the subjective, although he left it to my discretion. I told him I would refer the patient back to the GP and he agreed that was the appropriate decision. He did ask me to complete an objective examination, although it would be limited.
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