Sternoclavicular Joint

I have a friend who suffered a (R) sternoclavicular joint injury over a year ago when falling onto the point of his (R) shoulder in a football game. At the time he said the joint felt like it 'moved forward' and he was unable to raise his arm past 90 degrees. He rested for two games and found that he was able to gain full AROM of the GHJ however still complains that the joint doesn't fell 'quite right' during certain movements. The main movement that exacerbates his pain is eccentric horizontal extension (such as the lowering of a weight during chest press). I have found that although the clavicle rolls posteriorly as it is supposed to during this movement, the movement of the clavicle in the anterior direction on the manubrium is excessive and my friend claims that it feels 'unsteady'. Relying on my quick thinking (or lack there of) I tried to do a Jenny McConnel and invent a taping technique of my own! I couldn't find any info on effective taping for the SCJ so I placed an 'X tape' over the anterior SCJ, anchoring one piece at the sternum and pulling it over towards the medial border of the (R) scapula and one piece anchoring over the right rib cage (approx rib 5) over towards the medial border of the (L) scapula. For the first few sets of chest press, my friend found this effective but as he started to fatigue and move into more horizontal extension the clavicle started to move more anteriorly again and the pain began again. This truly is a strange case, any suggestions on treatment for the SCJ?

Expressive Aphasia

I am on my neuro prac at the moment and have come across an elderly lady who is now 5 days post (L) MCA stroke. From my assessment, it appears that the patient is able to understand spoken language and is able to answer simple 'yes' or 'no' questions, however suffers from expressive aphasia therefore I am unable to make any sense of her spoken words. She expresses herself fairly well using facial expressions, so I am able to detect if she is in pain or shows that she has a general interest in what is going on with our treatment sessions. I still feel that I could get more information from her non-verbally. I was wondering if anyone has come across a similar situation and has developed their own strategies to more effectively deal with the situaiton?

Negotiation and time managment

There has been several occasions in this prac where I had to wait for such a long time for the patient to get ready for therapy. One occasion was when 2 of the patients that I was suppose to see are both in the same room. This room had 4 patients and were all waiting to have a shower. I wish my supervisor who allocated these patients to me in the am could have told me...this would have saved a lot of time.

Negotiation with the staff could also be an nightmaire. I wrote in the shared diary that I would like my patient showered and in the chair ready for PT by 9:30. Then the nurse comes hustling in and happily told me that the patient is in the shower now and will be out in the chair in 10min. I thought great, however when I walked into the patient's room, she was still in her nighty waiting to hop into the shower. No matter how I managed to convince her to even do some UL ex in bed she refused boldly. I was not very pleased.

Patient Handling

Hi guys, I'm currently in G66 neurology and what I found really challenging was transfering stroke patients. Whether its performing sit to stand or from w/c to bed, or supine to sitting, applying our handling skills that we learnt at uni to a patient was totally different. Not in terms of hand positions but my body mechanics were all altered.

A patient with a dense L hemi basically slumps into you when you stand them up. We never had this kind of exposure. I mean I did anticipate what will happen when i stood the patient but I never knew it could feel so different. What I suggest is that practicing on peers are great to get the idea of what to do but what also would be great is to get them to actually act out and relax on one side of their body, then we will really get a sense of how much effort is required.

the over active patient

As a physiotherapist on a surgical ward, we spend most of our time convincing patients that getting out of bed, no matter how painful it is, will actually make a difference!! So when faced with a patient who wont stop walking 3 days post 4x CABG, i was lost on what to do. She has an interesting social history and is a carer for both her son and husband. This patient has just had open heart surgery and cant wait to get home so she can help out.

In terms of cardio problems, her SpO2 remains stable however she gets SOB post walking. Her chest is clear, she does ALL her breathing exercises, she does ALL her UL and LL exercises and she walks around as much as she can. The problem is.... she wont stop!!!

She has an anxious personality and is continuously on the move. I am currently trying limitation stratergies with her to minimise the work she is doing. I have told her to walk only 4-5 times a day and only do her breathing exercises 4 times a day. She is NOT to try ANY lifting of carer duties for the first 3 months. We are CONSTANTLY reminding her that she is to put herself first. If she is unwell and requires more surgery, it will take longer for her to recover completely. She is a hard patient to monitor because all the usual tricks don't apply.

Assumptions

Hi Everyone,

This experience happened to me on my last prac which was my rural. I was doing a community placement. During my second week, I was taking the No Falls group, along with the therapy assistant. We had a new patient, who had a long history of falls, and who's balance was severely decreased, and in hindsight was not really appropriate for that particular type of intervention. The therapy assistant and I were spending most of the time with this new pt, showing her what to do, however, one of the other paticipants of the class called me away, so I left the new pt with the therapy assistant, assuming that everything would be alright, as that particular activity was only standby assist. However, the new pt then had a fall. What I learned from this incident: Do not assume anything! The therapy assistant had a very confident personality, and I assumed that she knew more than she did. At the end of the day, we are the physios, we have the knowledge and no matter how confident (or bossy) a therapy assistant might be, we are the ones who have to take responsibility for all of our pts.

Osteitis Pubis

My recently completed self directed study involved researching some of the literature into the definition, aetiology, signs and symptoms, diagnosis and treatment for five common musculoskeletal conditions. One of these conditions was osteitis pubis. Unfortunately I could not find much literature relating to evidence based physiotherapy treatment for osteitis pubis. All I could find (as usual) were some very broad treatment/management ideas such as rest from aggravating activity (sit ups, twisting, forceful adduction), gentle massage, gentle stretching, core re-training etc...I was wondering if any of you guys had come across a patient with osteitis pubis or been a sufferer of osteitis pubis and shed some light on a specific exercise program that you had found useful in resolving this problem.

The Pusher Syndrome

I am on my neuro placement at the moment and have been treating a (R) MCA stroke patient (who is 6 days post-stroke) with my partner for the week. He has stage 1 voluntary movement of his (L) UL and LL, very low tone of his (L) LL and UL, no sensation (light touch or proprioception of his (L) UL and LL) and severe (L) sided neglect. We have tried some alignment and balance exercises with him sitting over the edge of the bed and have found that he tends to align himself posteriorly and to the left (as expected). To add to his tendency to bring his CoG posteriorly and to the left he often pushes with his non-hemiplegic hand to the left. As suggested, I have read the article on 'the pusher syndrome' however have found that their suggestions for PT treatment are limited and not so helpful as we havn't been able to take him to the gym yet or gain access to a mirror to help his sense of verticality. I have found that reminding him to place his (R) hand palm up on his lap is often useful to prevent him pushing but besides this I was wondering if anyone had come up with some other nifty treatments for this problem.

silly patients

As the year goes on, i am finding that i am getting sick of spending 90% of my time on 10% of perth's population who land themselves in hospital simply because they did something dumb. The trouble i have with these pts is firstly i think what's the point in treating them if they'll be discharged and they'll continue doing stupid stuff and as a result be back in hospital within a year...and the cycle goes on...Secondly, i figure that my time would be much better spent on those pts who can't help being admitted to hospital. I am probably being too judgemental, but does anyone else ever feel like this???

Dealing with other physio staff

I am on rural prac and have 2 supervisors. IOne of my supervisors wanted me to fully run the ward and see all of the patients by myself (as appropriate) which i was quite happy and able to do BUT a new physio has just started at the hospital and my other supervisor want her to do most of the work. The same supervisor also wanted the new physio to come on see all of my patients with me with the view of her taking all my caseload. This has lead to all of my patients going to the new physio and suddenly i have no say in what happens on the ward ot with any of the patients. Furthermore, of the one pt that they left me with, the new physio keeps telling me what treatments to do when they have said themselevs theyhave had little ward experience and they also don't know the pt from a bar of soap. I feel like i am getting caught up in the middle because one senior wants me to control the ward and the other (my clinical tutor) doesn't. Basically, i have been doing what my clinical tutor has told me to do but i am slowly getting more and more fed up because now i can't see my pts who i have worked so hard at treating them. I was considering explaining myself to the physio who wants me to do more around the ward, but i don't want to make a huge fuss or annoy my clinical tutor...Any ideas???