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

Notes:

Assume that today's date is 10 February 2019

You have been treating a patient, Sharyn Royale, who has right lateral epicondylitis. You are writing a letter back to her doctor, Dr Jones.

PATIENT DETAILS:

Name:                            Sharyn Royale (Ms), DOB: 25 Mar 1981

Occupation:                  Personal assistant

G.H.:                               Good, allergic to antibiotics, smoker (10 cigs/day), sedentary

Social:                           Single, lives with sister. Leisure: computer games; internet. Seems shy/nervous.

23 Jan 2019                   Patient referred by Dr Jones – suspected lateral epicondylitis

Complaint:

• 1 mth ago developed pain in R elbow when typing as pre-holiday workload Ó on computer.
• Moderate pain lateral elbow (6/10) with some radiation into forearm with prolonged typing and home-related tasks (e.g., turning on tap).
• Patient perceives loss of strength in R forearm, gradual onset over 2 wks. Typing: Painful
  after <15mins typing, elbow pain + (8/10).
• Handwriting: Painful after <15mins, elbow pain (5/10).
• R shoulder – occ dull ache, does not appear related to elbow pain. Dr advised 1 week off aggravated duties.

Physical examination:

• R shoulder: No apparent distress (NAD), cervical spine: NAD Tender on palpation (palp), R lateral
  epicondyle (6/10)
• Wrist extenstion (Ext): G4 with pain (5/10) Stretch ECRB/ECRL (forearm) pain (4/10)

Diagnosis:  R lateral epicondylitis

Treatment:

• Ultrasound (US) 0.8 w/cm 2 int. x7 mins to lateral epicondyle
• Specific soft tissue mobilisations (SSTM) x4 mins Eccentric loading exercise program 2x 10
  repetitions
• Advice re: icing, stretching and avoiding aggravated activities

25 Jan 2019

Complaint:

• No change in symptoms, and has not been typing

Examination:

• Reduced tender on palp (5/10). Less pain on resisted extension (4/10).

Treatment:

• US, massage, increased exercises
• Can restart duties: writing – 5 min; computer – avoid

27 Jan 2019

Complaint:

• Symptoms improved. Less pain turning on taps. 5 min writing OK.

Examination:

• Pain on palp (4/10). Ext stretch increase range, pain 2/10.

Treatment:

• US, SSTM, add weight 0.25kg to exercises
• Patient instructed to use weight with home exercises
• To try 5 min on computer every 2 hours

Patient on holidays for a week

03 Feb 2019

Complaint:

• Feeling better after holiday break.
• Can turn on taps with pain 1/10.
• Only used computer twice, but no pain.

Examination: Pain on palp 1/10. Wrist Ext 4+, pain 1/10

Treatment:

• Repeat US, SSTM
• Exercises increased weight to 0.5kg
• Instructed to use ergonomic wrist rest for wrist position for mouse work.
• To return to work on light duties. Max 5 min typing/hr for first day. No heavy lifting. If no change in symptoms, can increase by 5 min every second hour on Day 2. Day 3 can increase 10min each hour if no pain.

10 Feb 2019

Complaint:

• Symptoms better. No pain on turning on taps. Has increased computer time, sometimes to half
  an hour. Slight discomfort then. Employer is supportive of light duties.

Examination:

• Slight tenderness on palp (1/10), slight pain on resisted wrist Ext (1/10)

Treatment:

• US, SSTM, reviewed exercise regime.
• Patient advised to restrict duties. Asked to go back to Dr for review, seeking extension on light
  duties.

Writing Task:
Using the information in the case notes, write a letter back to the referring doctor, Dr Jones, for assessment of her
case and return to full duties at work. Address the letter to: Dr Felicia Jones, Fit Families Practice, 25 North Road,
Newtown.
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.