Learning scenarios : Upper limb

UPPER LIMB

CASE 1:

A 30 year old dancer is presenting with a  painful arc of abduction in her left shoulder. The pain is non severe. Non irritable.

Tasks on model:

  • Demonstrate an appropriate assessment procedure for subacromial pain syndrome (formally known as impingement) in the left shoulder joint.
  • Explain to the examiner what you are looking for.
  • Demonstrate an appropriate manual therapy treatment technique for this condition.
  • Justify your choice of treatment to the examiner and possible progression of treatment.

 

Hints and tips Hints and tips

Remember its the LEFT shoulder.

Be specific with your assessment and impingement tests.

Check out the latest research in manual therapy techniques. You will score higher marks if you can quote that your treatment is evidence based. Bear in mind limitations of the study ie if the study population was of elderly patients the tissue integrity and therefore effectiveness of treatment may be different to that of a 30 year old dancer!

CASE 2:

A 70 year old presents with a stiff right shoulder following a diagnosis of frozen shoulder, 1 year ago, he has mild pain, non irritable.

Tasks on the model:

  • Demonstrate how you would assess shoulder range of movement, with goniomertry where appropriate.
  • Explain to the examiner what you are looking for.
  • Demonstrate an appropriate passive physiological technique to increase lateral rotation of the glenohumeral joint.
  • Justify your choice of treatment to the examiner and possible progression of treatment.

 

Hints and tips Hints and tips

Remember its the RIGHT shoulder.

Which phase is the patient experiencing? How will effect your choices for treatment?

What is the latest research for adhesive capsulitis and manual therapy? Type these two keywords into a medline search and note 2 or 3 pieces of evidence that you can reference in your exam.

CASE 3 (Spinal dysfunction):

A 40 year old librarian presents with an 18month history of unilateral right neck, with referred pain into the right arm. It is not severe or irritable.

Tasks on the model:

  • Demonstrate how you would palpate the cervical spine.
  • Explain what you might expect to find with the clinical features outlined above.
  • Demonstrate a manual treatment techniques suitable for the managements of this patient.
  • Justify your choice to the examiner.
Hints and tips Hints and tips

Review your anatomy. Knowledge of surface anatomy and the structures that lie beneath will improve confidence of which structures are dysfunctional.

Learn the muscles and joint orientations (facets 45 degrees in the cervical spine) as these are often questions examiners ask.

Case 4 (Shoulder/TENS)

A 55 year old jockey is complaining of a left frozen shoulder (adhesive capsulitis). Symptoms are constant, severe (VAS 7/10) and irritable. You decided to use ‘Acupuncture-like’ TENS as part of their management program.The machine has been tested and there are no contraindications to its use.

Task on the model:

  • Demonstrate how you would position the patient to teach them the use of TENS and explain to the patient the reason for using TENS in teh management of their symptoms.
  • Teach the patient how to apply ‘Acupuncture-like’ TENS in the management of a painful left frozen shoulder.
  • Justify the use of TENS in the management of upper quadrant neuromusculoskeletal dysfunction.
Hints and tips Hints and tips

Research pain mechanisms.

Revise ‘acupuncture-like’ TENS and its effects on opiod mediated analgesia.

To find out more about TENS click here

Tables can be useful when gathering your thoughts and  building a record of your revision. The table below offers a framework and a check list.  Reflection and constructive criticism from a colleague will help improve your performance. By familiarising yourself with the routine of an examination will help reduce nerves within the exam.

 

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