Marjon Clinic – 23rd March 2021 for 2 hours

Within these hours, I planned appointments for two clients who were due to come into clinic, however these appointments had to be cancelled due to our supervisors having to self isolate. I also helped conduct a virtual session with another student in my year.

Reflective Summary

The clinical impression for the virtual appointment was a lateral meniscus tear, with a differential diagnosis of a ligament sprain/tear within the right knee.¬†Meniscal injuries, particularly tears, represent one of the most frequent lesions in sport, especially within the football population (Frizziero et al., 2012).¬†In younger patients, meniscal tears are normally traumatic where the mechanism of injury is characterised by twisting on a loaded flexed knee (McDermott, 2011). This is similar to the mechanism that the client reported as they said they went in for a tackle while playing football and landed funny. Moreover patients with a meniscal tear tend to report pain, as well as mechanical symptoms such as popping, catching and locking (Doral, Bilge, Huri, Turhan & Verdonk, 2018). A physical examination should be performed and include special provocative tests such as palpating for joint line tenderness as well as conducting McMurray’s, Apley’s and Thessaly’s special tests. It is important to bear in mind that the symptoms and physical findings for a meniscal injury may also present in ligamentous injuries (Doral et al., 2018). This is why we will also assess the ligaments in the knee. Meniscal injuries can be treated either conservatively or surgically (Frizziero et al., 2012). We will look at implementing specific rehabilitation exercises with the client to help improve symptoms. As my clients injury occurred 5 months ago, they do not present with any swelling or a reduction in range of movement (ROM). Therefore, a prescribed programme will focus on quadricep and hamstring strengthening, eventually progressing to dynamic proprioceptive training (Chirichella et al., 2019).

What Went Well

As my clients were unable to come in for their scheduled appointments, I sent personal emails to each of them to check in with their progress and find out if they are happy to come in next week.

Areas for Improvement Action Plan
Before any hands-on assessment or treatment can be done, consent needs to be given. Next time I have a face to face appointment, ensure I ask for consent verbally.
Continue to develop my knowledge on the presentation of different injuries. Block out revision time each week to begin preparing for my final year clinical exam.

Closing the Loop

Since writing this reflection, I always ensure that I ask for consent and have begun to revise for my final exam.

References

Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2019). Treatment of knee meniscus pathology: rehabilitation, surgery, and orthobiologics. PM&R, 11(3), 292-308.

Doral, M. N., Bilge, O., Huri, G., Turhan, E., & Verdonk, R. (2018). Modern treatment of meniscal tears. EFORT open reviews, 3(5), 260-268.

Frizziero, A., Ferrari, R., Giannotti, E., Ferroni, C., Poli, P., & Masiero, S. (2012). The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscles, Ligaments and Tendons Journal, 2(4), 295.

McDermott, I. (2011). Meniscal tears, repairs and replacement: their relevance to osteoarthritis of the knee. British journal of sports medicine, 45(4), 292-297.

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