Well did my mock CCA. Bit of a strange experience but I guess it was going to be.
My continuation patient was a 34 year old man who presented to me 6 weeks prior with Low Back Pain and I diagnosed an annular strain. After answering a few questions on his management plan and progression it was time to see my new patient.
New patient was a 35 year old women with generalised low and mid Tspine pain. She'd had a breast reduction 5 years earlier as her large breasts were giving her back ache. She'd put on weight recently and her back ache had returned.
I didn't get asked many questions about her apart from ergonomic type questions about sitting posture and chair wedges which I don't think I answered very well at all.
Note to self ... make sure I know more about this for the future.
Friday 27 November 2009
Tuesday 24 November 2009
S-CS: L5 Somatic
Well Ive just finished a session in Bethnal Green. I was working with a 72 year old gentleman with a history of chronic low back pain. Due to his age and marked OA changes on xray of his LSpine he isn't a candidate for HVT hence I tired to treat his back pain with S-CS.
The patient appeared to accept that it was a appropriate choice of treatment for his low back. I found it hard to locate his tender-point as I had to place couch roll over his boxers shorts as they were stained in urine, but I managed to make sure that everything was kept out of the way.
Unfortunately I wont be seeing this patient again to follow up (as its the end of my placement) to see how effective S-CS was for his back pain.
Tuesday 17 November 2009
Technique - CT Junction
Ive never been able to thrust a CT. From observation in clinic prone seems to be the most popular technique chosen by other students and tutors, followed by a lift off. I cant get either :-(((
17/01/10 - Having identified in that I'm struggling with CT thrusts a clinic tutor talked me through how she does her CT thrusts supine. She adds lots of side shift of the cervical spine down to the CT before applying any other levers. She allowed me to try the technique on her (which I was surprised about) ... and thankfully it was the first CT thrust I managed to get ... and it was supine, not the easiest of techniques I hasten to add.
11/04/10 - I'm still moaning to everyone about not getting my CT thrusts when another of the fourth years offers to show me how he does his prone technique. Theres nothing new about the technique compared to what we have been shown in technique apart from the addition of placing the tips of the fingers onto the SP of T1 whilst applying the side bending to ensure that the side bending go down to the CT. Then carry on as normal. Penny lent here CT to me to try ... I cavitated both sides ... I returned to favour to her and she got both sides ... one side even cavitated without the thrust.
23/04/10 - After my success with the prone technique one of the senior clinic tutors showed me her side lying technique. It really got me thinking about the levers and feeling what is happening at the joint instead of practising rehearsed application of the levers ... I haven't been very successful with this technique but when it does work it is very effective and non-traumatic for the patient compared to some of the prone thrusts we do.
12/05/10 - I think Ive now got 12 CT thrusts in a row with my new revised prone technique ... Ive even been able to teach others how to do it ....
17/01/10 - Having identified in that I'm struggling with CT thrusts a clinic tutor talked me through how she does her CT thrusts supine. She adds lots of side shift of the cervical spine down to the CT before applying any other levers. She allowed me to try the technique on her (which I was surprised about) ... and thankfully it was the first CT thrust I managed to get ... and it was supine, not the easiest of techniques I hasten to add.
11/04/10 - I'm still moaning to everyone about not getting my CT thrusts when another of the fourth years offers to show me how he does his prone technique. Theres nothing new about the technique compared to what we have been shown in technique apart from the addition of placing the tips of the fingers onto the SP of T1 whilst applying the side bending to ensure that the side bending go down to the CT. Then carry on as normal. Penny lent here CT to me to try ... I cavitated both sides ... I returned to favour to her and she got both sides ... one side even cavitated without the thrust.
23/04/10 - After my success with the prone technique one of the senior clinic tutors showed me her side lying technique. It really got me thinking about the levers and feeling what is happening at the joint instead of practising rehearsed application of the levers ... I haven't been very successful with this technique but when it does work it is very effective and non-traumatic for the patient compared to some of the prone thrusts we do.
12/05/10 - I think Ive now got 12 CT thrusts in a row with my new revised prone technique ... Ive even been able to teach others how to do it ....
Tuesday 10 November 2009
Technique - Thoracic Spine
24/11/09 - I don't know whats happened to my Dog but Ive lost it .... I think I'm over complicating things. Watching some clinic tutors Dog and they just appear to circle over the patient until they feel the tension then drop. Where I actively thing about side bending, flexion, extension and rotation etc
21/04/10 - Well it looks like its not just my rib TSpine thrusts that I'm struggling with its also my Ribs !!! Had a 34 year old man today with a rib lesion that needed manipulating. Once I managed to work out which side the left rib was when the patient was laying down (how embarrassing) I attempted to thrust his rib. All I managed to do was hurt him. Need to practice my rib thrusts before he comes back next week.
28/04/10 - My rib patient came back. Good news was he was feeling some improvement in the intensity of his pain and also the area of pain was more localised to that rib 4 lesion. I attempted it again, twice and failed to get a cavitation (I know its about quality of movement but still !!!). My tutor then attempted to mobilise the rib for me. He took two attempts. On discussion with my tutor after he said that the rib just didn't want to seem to move so he elected to thrust the TSpine to improve the movement in the segment as a whole. This made me feel better in my failed attempts.
05/05/10 - Rib patient is back ... symptoms are improving further as expected. Still I wanted to mobilise that rib. This time I had listened to the feedback that my tutor had given me on the previous weeks about rotating over the patient and pronating my fulcrum more and at last the rib mobilised. Im looking forward to seeing what improvement this will have made next week.
21/04/10 - Well it looks like its not just my rib TSpine thrusts that I'm struggling with its also my Ribs !!! Had a 34 year old man today with a rib lesion that needed manipulating. Once I managed to work out which side the left rib was when the patient was laying down (how embarrassing) I attempted to thrust his rib. All I managed to do was hurt him. Need to practice my rib thrusts before he comes back next week.
28/04/10 - My rib patient came back. Good news was he was feeling some improvement in the intensity of his pain and also the area of pain was more localised to that rib 4 lesion. I attempted it again, twice and failed to get a cavitation (I know its about quality of movement but still !!!). My tutor then attempted to mobilise the rib for me. He took two attempts. On discussion with my tutor after he said that the rib just didn't want to seem to move so he elected to thrust the TSpine to improve the movement in the segment as a whole. This made me feel better in my failed attempts.
05/05/10 - Rib patient is back ... symptoms are improving further as expected. Still I wanted to mobilise that rib. This time I had listened to the feedback that my tutor had given me on the previous weeks about rotating over the patient and pronating my fulcrum more and at last the rib mobilised. Im looking forward to seeing what improvement this will have made next week.
Tuesday 3 November 2009
Technique - Glenohumeral and Shoulder Orthopedic Tests
03/11/09 - So many orthopedic tests for the GH ... Im really struggling to remember them all, especially by name and need to improve SLAP lesion examinations.
http://www.prohealthsys.com/
12/11/09 - Keira Kinch Tutorial - GH Examination
The tutors allowed us to select the topic of of tutorials this term so I suggested that it would be helpful to see how they performed a shoulder/GH examination.
Keira suggested that we do some further research on shoulder examinations and I came across this resource on the Internet.
http://www.prohealthsys.com/physical/shoulder_exam.php
Again Keira was great at showing us how to perform the tests accurately and how to interpret what we found.
Having never seen a patient with Adhesive Capsulitis through out the whole course I saw two in one week during the Easter vacation. Thankfully I had another student with me who was more familiar with them than myself. I vaguely remembered the capsule stretches that you need to do and to stretch the shoulder to the point before its painful for the patient. The other student gave the patient an exercise to do whereby they stretched their GH capsule in front of a mirror to ensure that they were not using side bending to assist (see video).
http://www.prohealthsys.com/
12/11/09 - Keira Kinch Tutorial - GH Examination
The tutors allowed us to select the topic of of tutorials this term so I suggested that it would be helpful to see how they performed a shoulder/GH examination.
Keira suggested that we do some further research on shoulder examinations and I came across this resource on the Internet.
http://www.prohealthsys.com/physical/shoulder_exam.php
Again Keira was great at showing us how to perform the tests accurately and how to interpret what we found.
Having never seen a patient with Adhesive Capsulitis through out the whole course I saw two in one week during the Easter vacation. Thankfully I had another student with me who was more familiar with them than myself. I vaguely remembered the capsule stretches that you need to do and to stretch the shoulder to the point before its painful for the patient. The other student gave the patient an exercise to do whereby they stretched their GH capsule in front of a mirror to ensure that they were not using side bending to assist (see video).
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