On Friday our first client cancelled. After waiting around this was a bit disappointing! I spent some time answering some of the questions in the workbook. Seeing only one client that day seems like a waste of a day. The other physios did let me sit in on some of their sessions with other clients. We asked if there was anything we could do since we had a lot of spare time, but nobody had any tasks for us. In the info we were given it mentioned doing some research and a presentation so I will look into that next week. It has been easy to keep busy though – I’ve been studying some of the conditions we have come across and have been going over the notes I have made. I now feel a lot more confident about filling in the examination form. It will also be good to use this time to over some of the UL techniques for exams after prac.
On Friday we had our first client where we could not work out what was going on with her shoulder. This situation is discussed below. It was certainly a great learning experience.
1. We had a client come in with shoulder pain that extended down her arm. We were not given a diagnosis in the referral and therefore had to try and work it out for ourselves. In some ways, this is a lot more satisfying than having the diagnosis handed to us. We ran through the subjective history and then went through a number of tests in the objective examination to try and pinpoint exactly what structure was causing the pain. We did integrity tests for the rotator cuff muscles, impingement tests, ligament integrity tests, and just about every other tests we could think of. They all came back negative – so we knew what wasn’t causing the pain, but couldn’t work out what was! In the end another physio came in to look at her shoulder (he specializes in this area). It was really good as he explained to us everything he was doing. We should have known to look at the cervical spine – we only asked her about it, and didn’t actually look at her neck movements. The physio also showed us how to look at the MRI scans. I found this really interesting as we have not really done this at uni. In the end the physio worked out it was a problem at the AC joint. He also quizzed us on cranial nerves which I had no idea about!! Better revise them! We gave the client IF treatment but couldn’t do passive accessories on the AC joint as she was too sore from all the poking and prodding from the examination. We plan to do this next time we see her.
2. As for what we did well…we ruled out a lot of structures that could possibly have been causing the pain. We remembered the tests we had to do (for example, impingement and integrity). We didn’t look at the cervical spine or AC joint, which we should have. In the future we need to remember to look at the all joints above and below the pain and assess all of them so we don’t miss anything. We sorted out the IF machine and have planned what we have to do with the client next time. I thought we took a good subjective history and gave a good treatment. We didn’t do so well with the diagnosing of the problem though!
3. I felt comfortable with the client – she was very friendly and cooperative. We took awhile with our assessment and she was very patient. I wasn’t very confident after ruling out everything we could and then still not having a diagnosis!
4. From now on I will definitely be looking at all joints around the area! When we are trying to work out the source of the pain we should think more laterally and consider different structures.
5. Again, just making sure we examine all the different joints and structures in the area if we cannot work out the source of the pain.
6. The day dragged on a bit as we weren’t very busy. It was quite productive in the paperwork and study I managed to get done, but seeing only one of our own clients makes it feel like we wasted a lot of time.
7. I will look into the presentation or other ideas for things to do in our spare time.
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