Whilst on my musculoskeletal outpatients prac I realised the value of taking note of every observation, no matter how insignificant it may appear. I also learnt that experience is worth it's weight in gold!
i had a patient come in, an elderly lady who presented with resting pain in both shoulders, her Cx, both elbows and occasionally pain in both legs. She had decreased range of motion bilaterally, limited by pain and it was impossible to make a complete assessment of her due to her pain levels! I treated her quite globally in the first session with STM of UT and LS combined with heat as well as AP mobs of both shoulders, both of these decreased her pain and increased her range slightly. On the second assessment she was back to the same pain levels and decreased range and the effects of the last treatment had only lasted a short period without her overexerting herself or doing anything different then normal. All of these findings tended to lean towards an inflamatory cause. I had noticed that she had quite widespread psoriasis but hadn't really thought enything of it. My supervisor came in to have a look at my patient and straight away noticed the psoriasis. It turned out that this lady had had the psoriasis for a long time and had not seeked any professional assistance with it.
We then referred this lady to her GP who referred her to a rhematologist aswe believed her problem to be psoriatic arthritis!!
I had remembered learning about this condition in our arthridities lectures and had noticed the psoriasis but had not made the connection. This expereice just showed to me the value of linking your observations, no matter how insignificant they appear to you, and your assessment findings. It did help that my supervisior had a few years of experience and had come across this condition before!
1 comment:
I found that post really interesting. Not only is it important to link observations to our own assessment findings, but also to take special notice if any of these indicate 'red flags' to treatment, where our input is not necessarily the best thing for the patient, and to refer them back to their GP for further investigations- its always better to be safe than sorry! Noticing that her symptoms had improved with treatment, but then gone back to the same as previously not long after was an important subjective re-assessment that made you think of that to. Good work!
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