Date: 28/04/2021

Hours: 6

Total hours: 58

The first client seen in this session was being observed for knee pain after pregnancy. The client has been struggling with exercise after their recent pregnancy and has been suffering with knee pain for the last few months. An objective assessment was completed on the client’s right knee, the ROM of the knee was assessed in flexion, extension, internal/external rotation where there was no pain present. The client claimed that there was pain during functional movements such as walking up and down the stairs and squatting, this has given them some fear of movement when going back to the gym after pregnancy.

Special tests were also completed including anterior/posterior drawer test to identify any damage to the ACL/PCL, a medial/lateral stress test were also carried out for the MCL/LCL, all tests were negative ruling out a possible damage to the knee ligaments. Due to the client’s pain when walking down the stairs, this suggested some meniscus damage due to pain when extra force was applied to the knee, to help rule out this diagnosis, the McMurray’s special test was completed. This was to apply force through the meniscus and identify any pain or changes in weight baring, however this test was also negative ruling out this differential diagnosis.

As the client had a C section, this could result in a reduced core strength as the surgery targets some of the main abdominal muscles. One of the main focuses when working with this client was to help gradually increase their core strength. The client was provided with exercises by the therapist which consisted of glute bridges and squats that were regressed to a sit to stand with a cushion.

The second client of this session was a follow up patient for a hamstring strain, the client was triaged the previous week. However, the client was unable to attend the appointment so further research into the causes of hamstring injuries was conducted instead as CPD.

The final appointment was an online triage with a 50-year-old female client with left shoulder pain which has been radiating down their arm. The pain was mostly around the back and the top of the shoulder with some neck tension. The client finds that the pain increases when they are at work as a hairdresser which they have been doing for approximately 35 years. They described the pain as a sharp pain in the arm and shoulder. They have found that the pain is aggravated by lying on their side with functional movements such as getting dressed or putting on a coat increasing the pain. The client has previously been doing some yoga which they have found to help ease the pain.

Some observations were made during the triage which involved assessing the ROM of the shoulder in flexion, extension, internal/external rotation, abduction, and adduction with some pain during 45 degrees flexion however no pain in any other movements. ROM of the cervical spine was also assessed in flexion, extension, rotation, and side flexion where some tightness was experienced in right side flexion and it was noticed that on the left, the client was bringing their shoulder to their ear which suggested that there was some guarding.

The clinical impression from this was Cervical radiculopathy C7/C8 and a differential diagnosis of tendinopathy impingement subscapularis. This was due to the location of the pain and the movement in which bought on the pain in flexion and during 45 degrees adduction, this would impinge the tendon at the subacromial joint space.

The client is to be seen for a face to face follow up appointment the next week where further objective assessment will be carried out to assess PROM, palpations, neurological screening, and special tests of the shoulder and rotator cuff.

For this follow up appointment, further revision and research is to be carried out on neuromuscular tests and screening to help improve knowledge and understanding of the upper motor neurone lesion.