Marjon Clinic – 26th April 2021 for 2 hours

I continue to treat and manage a client who is now eight weeks post lumbar spinal surgery. Within this session, I conducted a full shoulder assessment as a previous ultrasound scan relieved that the client has a lot of wear and tear within the joint, which could be the reason for pain in and around the shoulder.

Reflective Summary

This week the client brought in a report that summarised the results from an ultrasound scan that was conducted on their shoulder. This was done a few years ago.

A tendinopathy addresses pathology of the tendon; the typical parallel, longitudinal collagenous architecture becomes disrupted so lacks the orderly structure of a normal tendon (Raney, Thankam, Dilisio & Agrawal, 2017). This type of pathology is characterised by overuse and presents in the affected tendon as pain during activity. Additionally, the pain and degeneration of tissue can lead to decreased ability to tolerate tension on the tendon and consequently decreased functional strength (Raney et al., 2017). This was solidified during the objective assessment as the client had decreased muscle strength during resisted movements in flexion, abduction and external rotation. In the report it also states that the biceps tendon are subluxed; this means that the biceps tendon has partially dislocated so popped out of the bicipital groove, which can cause pain as the tendon sheath (lining of the tendon) becomes inflamed. Research has found that subluxations of the long head of the biceps tendon is commonly associated with lesions of the rotator cuff, especially the subscapularis tendon (Koh, Kim & Yoo, 2017), which the client presented with.

The client also has an achy pain on the medial side of the knee. I believe the clinical impression to be muscular tightness as the client struggles in active ranges of movement. The affected muscle could either be the gracilis or satorius based on where the clients pain is and the insertion of the muscles; both the gracilis and satorius insert proximally at the medial shaft of the tibia (Biel, 2012).

What Went Well

I believe that I completed a thorough objective assessment for the shoulder in order to identify whether the problem is related to contractile or non-contractile structures. This aids the specific choice of treatment and management.

Areas for Improvement Action Plan
Revise anatomy including origins and insertions so I can picture where structures are located. Add 20 minutes of anatomy revision into my daily routine.
Be able to understand and interpret imaging / reports that clients may have received from healthcare professionals. Investigate what my clients report suggests.

Closing the Loop

Since writing this reflection, I have begun to revise anatomy for the exam and feel a lot more confident with origins and insertions.


Biel (2014). Trail guide to the body: A hands on guide to locating muscles, bones and more. Boulder, USA: Books of Discovery.

Koh, K. H., Kim, S. C., & Yoo, J. C. (2017). Arthroscopic evaluation of subluxation of the long head of the biceps tendon and its relationship with subscapularis tears. Clinics in orthopedic surgery, 9(3), 332.

Raney, E. B., Thankam, F. G., Dilisio, M. F., & Agrawal, D. K. (2017). Pain and the pathogenesis of biceps tendinopathy. American journal of translational research, 9(6), 2668.


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