The Big Physio Survey - Example of Clinical 2

Keywords

Lateral Epicondylitis, Acupuncture, MWMs, Radial Nerve, Elbow, Assessment.

Who or what is my case report based on?

A patient - chronic left lateral elbow pain with associated weakness in his left hand.

What is the physiotherapy event or episode of care?

New episode of care - first assessment.

What were the aims of the physiotherapy event or episode of care?

To complete full subjective and objective assessment
To meet the patient's expectations - he wished to know what the diagnosis was and how to improve things
To begin treatment where appropriate/set out management plan.

What did I do?

Completed full assessment of the patient:
- Gained consent.
- Took detailed subjective Hx, cleared all red-flags.
- Cleared CxSpine/GHJ/UL neuro.
- Ascertained the symptoms were definitely coming from the elbow and that the weakness of his grip was due to pain-inhibition.
- Diagnosed as a lateral epicondylitis with radial nerve sensitisation - explained this to the patient and reassured him - gave him timescales for improvement and explained physiotherapy management plan.
- Commenced acupuncture Rx (Left LI14/11/10/4 + TE5, 10 mins initially).
- Did some MWMs (lateral glide L elbow whilst the patient actively clenched his fist).
- Taped to offload his common extensor origin.
- Provided with home-exercise programme (radial nerve slider+glider, eccentric wrist ext, wrist ext stretch).
- Advised on use of epiclasp splint if found taping effective.
- Booked review appointment in 1/12.
- Documented the session.

What was the outcome or effect?

- I was able to make a solid diagnosis and set out a management plan for the patient.
- The patient felt reassured and empowered to help his own symptoms.
- The patient had a strong autonomic effect to the acupuncture at the time - unable to ascertain outcome in session as too soon.
- The MWMs alleviated the patient's pain/weakness on clenching his fist during Rx and immediately after.

Why did I do this?

- To meet the patient's expectations/understanding and to get him on board with physiotherapy.
- To meet professional/legal standards in line with HCPC/CSP/company policies and procedures.
- Acupuncture was used as I previously wrote a case-study on its use in lateral epicondylitis and was able to back it up with recent evidence. Also from experience of high success in other patients.
- MWMs were used as I attended an Ed Wilson course on them last year and so far have had a good success rate in practice.
- Home-exercise programme to target specific findings from my assessment and to begin to encourage self-management - + evidence for eccentric loading in lateral epicondylitis.