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

Notes:

Assume that today's date is 30 August 2019.

You are a physiotherapist at the Underhill Physiotherapy Clinic. A new patient, Mrs Melanie Wright, consults you about
pain in her left knee.

PATIENT DETAILS:
Name:                           Mrs Melanie Wright

Date of birth:             08 June 1973

Social background:

• Works as teacher F/T
• Keen walker: 4x 1hr/week + circuit class x2/week
• 2 children; youngest 5yrs

Medical history:

• Partial meniscectomy in R (1990) & L (2000)
• Gym exercises for 3 weeks prior

30 Aug 2019
Presenting problem:

• Intermittent medial L knee pain 3/10. Some swelling
• Intermittent tightness L posterior thigh
• Occasional lower back pain – not related

Current background:

• 2 weeks ago, Pt turned suddenly while walking and felt something ‘pop’ in her L knee -> swelled up some hours after -> iced and rested. Self-medicated with Paracetamol (Panadol). Waited for improvement
• No giving way. Some locking and unable to straighten

Agg:

• Unpredictable; swells by end of day; cannot straighten

Irritability:                            

• Moderate

Eases:                                      

•   Likes it bent a little

24-Hour behaviour:

Night                                         Wakes her and makes getting to sleep difficult
AM                                              Better
Day                                             By afternoon more swollen

Previous treatment:         Nil

Investigations/X-rays:  Nil

Current medication:         

• Glucosamine
• Felodipine for high BP

General history:              

• Recent sinus infection

Screening questions:

• Weight loss
• Steroids

Objective exam:
Observation

• Limping, unable to straighten knee

Functional tests

• Ascending stairs difficult and slow

Active ROM

• Lacks full extension and flexion
  

Passive ROM

• Pain on passive extension
• Tightness in hamstrings

Joint integrity tests           ACL, PCL, LCL, MCL – all NAD
Palpation                                 Tender on anteromedial joint line
Impression/Diagnosis:   Further damage to L medial meniscus
Action:

• Condition explained
• Informed consent given
• Educated about condition
• Advised to have further investigations: ? X-ray/MRI/arthroscopy; consult Dr
• Advised to replace weight-bearing activity, use swimming for fitness in meantime
• Letter to Dr outlining findings
• R/V: phone with results of visit to Dr
• NB: Pt has no GP in Underhill (new in town). Requested recommendation

Writing Task:
Using the information given in the case notes, write a letter of referral to Dr Delbridge, a general practitioner, at
Underhill Medical Centre, outlining the patient’s presenting complaint, relevant medical history and your assessment,
and request further investigations. Address the letter to Dr David Delbridge, Underhill Medical Centre, 71 Jewel
Crescent, Underhill.

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.