Read the case notes and complete the writing task which follows.

Notes:

Assume that today's date is 1 May 2018

You are a physiotherapist in private practice. Max Wolff has been referred to you by his doctor, Dr William Stacey, for review and a treatment plan after presenting with chronic back pain. Mr Wolff visited you yesterday.

PATIENT DETAILS:

Name:                        Max Wolff (Mr)

Age:                            35

Profession:

  • Full-time musician: orchestral double bass player
  • Lives with spouse, also a musician
  • No dependants

Physiotheraphy Notes - from initial consultation 30 Apr 2018

Family/Patient History:

  • Father (70) has mild osteoarthritis; mother (67) healthy Younger brother & sister healthy
  • Tonsillectomy/adenoidectomy (1979) Myopic (corrective lenses since age 14)
  • Non-smoker; ‘social’ drinker (8-10 units/week)
  • Mild idiopathic scoliosis (<20º, untreated) since teenage years: slouching at desk while studying at
    school & music college
  • Minor, ongoing postural problems from music college to present: daily work routine (practising, attending rehearsals & performing with orchestra); pain not a problem until recently
  • Little formal exercise (no sports, no gym); busy schedule, with frequent evening work

Subjective:

  • Pt complains of ongoing upper back pain – feels stiff, ‘frozen’, ‘locked’ between shoulders; also dull
    pain in lumbar region
  • Agg: prolonged performance on instrument (>2 hrs); ease: rest
  • Symptoms developing over last 6-10 months; pt too busy at work to attend doctor; has been using non- prescription analgesics lately for relief (to help with sleep, esp. after evening performances)
  • Bass playing requires particular body posture – pt normally sits on high stool with body weight mainly on R leg; L arm is bent & raised up to near pt’s ear on instrument, R arm reaches forward to produce sound with bow. Unbalanced posture.
  • Pt concerned that current symptoms may prevent participation in important international tour with orchestra (for 1 month, leaving in 3 weeks) – this was trigger to attend doctor.
  • Also aware, however, of need to find & treat cause of current symptoms to maintain long-
    term health & continued capacity to perform (= earn).

Physical Examination Findings:

  • Standing posture – mild thoracic kyphosis with protraction of both scapulae & forward head
    posture. Average build with lax abdominal muscles.
  • Flexion in standing – fingertips 10cm below knees, mild scoliosis convex on right.
    Extension in standing – stiff ++
  • Side flexion in standing – fingertips to knee on left – complains of right lumbar tightness;
    fingertips 5cm above knee on right with stiff segment T3-T8.
  • Spinal rotation in sitting – stiff end of range to left but range normal. Pain reproduced with
    overpressure; ¾ range to right – stiff segment T3-T8.
  • Palpation – increased tone & tenderness left erector spinae T6-T8 & right erector spinae L2-L4.
  • Stiff PA central & right unilateral T3-T8.

Treatment Plan:

  • Posture training including cross-tape to mid thoracic spine to promote postural awareness &
    self- correction of forward posture.
  • Soft tissue releases left erector spinae T6-T8 & right erector spinae L2-L4. Spinal mobilisation
    T3-T8 to increase extension & right rotation.
  • Home exercises: Right side flexion in sitting bringing left arm over head; right rotation in sitting
    with hands behind neck, elbows forward – eight repetitions of each exercise with 10 second
    stretch at end of range – repeat four times each day.
  • Review twice each week until departure – introduce strength exercises & self-massage using
    tennis ball at next session. Advised patient that problem is not acute – should be able to
    participate in tour but will need to exercise, do self-massage & use tape for posture while away.

Writing Task:

Using the information in the notes, write a letter back to the referring doctor detailing your findings and suggested treatment plan. Address your letter to Dr William Stacey, Greywalls Clinic, 23 Station Road, Greywalls.

In your answer:

  •  Expand the relevant notes into complete sentences
  • Do not use note form
  • Use letter format

The body of the letter should be approximately 180–200 words.

Write your response in the textbox below.

Submit
0 words

Read the case notes and complete the writing task which follows.

Notes:

Assume that today's date is 1 May 2018

You are a physiotherapist in private practice. Max Wolff has been referred to you by his doctor, Dr William Stacey, for review and a treatment plan after presenting with chronic back pain. Mr Wolff visited you yesterday.

PATIENT DETAILS:

Name:                        Max Wolff (Mr)

Age:                            35

Profession:

  • Full-time musician: orchestral double bass player
  • Lives with spouse, also a musician
  • No dependants

Physiotheraphy Notes - from initial consultation 30 Apr 2018

Family/Patient History:

  • Father (70) has mild osteoarthritis; mother (67) healthy Younger brother & sister healthy
  • Tonsillectomy/adenoidectomy (1979) Myopic (corrective lenses since age 14)
  • Non-smoker; ‘social’ drinker (8-10 units/week)
  • Mild idiopathic scoliosis (<20º, untreated) since teenage years: slouching at desk while studying at
    school & music college
  • Minor, ongoing postural problems from music college to present: daily work routine (practising, attending rehearsals & performing with orchestra); pain not a problem until recently
  • Little formal exercise (no sports, no gym); busy schedule, with frequent evening work

Subjective:

  • Pt complains of ongoing upper back pain – feels stiff, ‘frozen’, ‘locked’ between shoulders; also dull
    pain in lumbar region
  • Agg: prolonged performance on instrument (>2 hrs); ease: rest
  • Symptoms developing over last 6-10 months; pt too busy at work to attend doctor; has been using non- prescription analgesics lately for relief (to help with sleep, esp. after evening performances)
  • Bass playing requires particular body posture – pt normally sits on high stool with body weight mainly on R leg; L arm is bent & raised up to near pt’s ear on instrument, R arm reaches forward to produce sound with bow. Unbalanced posture.
  • Pt concerned that current symptoms may prevent participation in important international tour with orchestra (for 1 month, leaving in 3 weeks) – this was trigger to attend doctor.
  • Also aware, however, of need to find & treat cause of current symptoms to maintain long-
    term health & continued capacity to perform (= earn).

Physical Examination Findings:

  • Standing posture – mild thoracic kyphosis with protraction of both scapulae & forward head
    posture. Average build with lax abdominal muscles.
  • Flexion in standing – fingertips 10cm below knees, mild scoliosis convex on right.
    Extension in standing – stiff ++
  • Side flexion in standing – fingertips to knee on left – complains of right lumbar tightness;
    fingertips 5cm above knee on right with stiff segment T3-T8.
  • Spinal rotation in sitting – stiff end of range to left but range normal. Pain reproduced with
    overpressure; ¾ range to right – stiff segment T3-T8.
  • Palpation – increased tone & tenderness left erector spinae T6-T8 & right erector spinae L2-L4.
  • Stiff PA central & right unilateral T3-T8.

Treatment Plan:

  • Posture training including cross-tape to mid thoracic spine to promote postural awareness &
    self- correction of forward posture.
  • Soft tissue releases left erector spinae T6-T8 & right erector spinae L2-L4. Spinal mobilisation
    T3-T8 to increase extension & right rotation.
  • Home exercises: Right side flexion in sitting bringing left arm over head; right rotation in sitting
    with hands behind neck, elbows forward – eight repetitions of each exercise with 10 second
    stretch at end of range – repeat four times each day.
  • Review twice each week until departure – introduce strength exercises & self-massage using
    tennis ball at next session. Advised patient that problem is not acute – should be able to
    participate in tour but will need to exercise, do self-massage & use tape for posture while away.

Writing Task:

Using the information in the notes, write a letter back to the referring doctor detailing your findings and suggested treatment plan. Address your letter to Dr William Stacey, Greywalls Clinic, 23 Station Road, Greywalls.

In your answer:

  •  Expand the relevant notes into complete sentences
  • Do not use note form
  • Use letter format

The body of the letter should be approximately 180–200 words.

*The above and below containers are scrollable

Write your response in the textbox below.

Submit
0 words