GP Notes

Patient presents with pain along the Achilles tendon Also complains of the following symptoms: -Swelling of the skin over the tendon with warmth, redness and tenderness -Pain when rising up on the toes and pain with pushing off on the toes -Painful heel for the first few minutes of walking and waking up in the morning -Stiffness of the ankle which improves with mild activity On Examination: Patient has tenderness to palpation over the Achilles tendon Clinical impression: Achilles tendinitis Management: 1. gentle calf stretching 2. strengthening of the Achilles tendon 3. Eccentric calf raises 4. May need to consider heel raise or orthotics if pain does not settle 5. as symptoms resolve, resumed normal weight-bearing activities gradually 6. avoid running until the tenderness is gone. Swimming or cycling in low gear a good replacement activities Prevention of Achillies Tendonitis: - do strengthening and stretching exercises to keep calf muscle strong and flexible - Keep yo...

Patient presents with pain in the hand Side: Pins and needles shooting down from the wrist joint into the hand Reduced strength Worse after manual labour Examination: Hand examination: Loss of muscle mass over the thenar eminance Tinels test positive Phalens test positive Diagnosis: Carpal Tunnel Syndrome Management: Disucssed treatment options 1. Steroid injection into the wrist joint for temporary relief 2. Referral to orthopaedic surgeon for Carpal Tunnel release Keywords:  +CTS

Patient presents with pain in the heel Side: Worse when steps out of bed Relieved after walking Increases toward the end of the day Worse after sitting Examination: Tenderness to palpation over the heel Location: No gait abnormality Reason for visit: Plantar fasciitis Management: 1. Rest from long walks and running 2. Regular anti-inflammatories 3. Plantar fascia stretching exercises 4. Good footwear with prefabricated insoles Advised that if symptoms do not settle we can refer for a steroid injection in the plantar fascia Keywords: +plantarfasciitis

Patient presents with in the elbow The pain refers down the back on the forearm Occurs at rest The pain occurs during gripping hand movements, particularly on rotation / turning, picking up objects with a grasping action, carrying buckets etc Side: Examination: No visible swelling Localised tenderness over the lateral epicondyle, anteriorly Pain on passive stretching wrist Pain on resisted extension of the wrist and third finger Normal elbow movement Reason for visit: Tennis elbow Management: 1. Rest from offending activity 2. Rest, ice, compression, elevation and oral NSAIDs 3. stretching and strengthening exercises Exercises The dumbbell exercise Use a dumbbell or similar type of weight such as a bucket of water. Start with 0.5 kg (1 lb) and build up gradually to 5 kg. 1. Sit in a chair beside a table. 2. Rest your arm on the table so that the wrist is over the edge. 3. With your palm facing downwards, grasp the weight. 4. Slowly raise and lower the wei...

Patient presents with swelling and pain localised over the olecranon process Side: The patient is systemically well Examination: Swelling without any marked tenderness over affected elbow Normal ROM in the joint No evidence of overlying cellulitis Reason for visit: Olecranon bursitis Management: Advised the patient of the diagnosis and explained treatment options 1. Observe 2. NSAIDS 3. Needle aspiration Patient elected for needle aspiration Consented Verbally for the procedure Area cleaned and performed under sterile conditions Swelling localied and 1% Xylocaine infiltrated into the skin overlying the bursa 18g Sharp needle inserted into the bursa Aspiration of about 20ml of clear fluid consistant with synovial fluid wound dressed and patient advised to return if : - swelling - redness - fevers - Pain - any concern the patient has Simple analgesia advised to be used Keywords:  Olecranon bursitis, +olecranonbursitis

Side Examined:  Look: Knee appears normal with no obvious swelling, redness or trauma Feel: Palpation of the medial collateral ligament  - normal Palpation of the lateral collateral ligament  - Normal Palpation over the medical meniscus - Normal Palpation of the lateral meniscus - Normal No hypermobility of patella No tenderness of the popliteal fossa Move Anterior draw:  Normal Posterior draw: Normal Testing of collateral ligaments: Normal McMurrays test: Normal Keywords:  Knee Examination, Knee exam, +kneeexam

Patient presents with pain in the shoulder Side: History: No stiffness or restriction No excessive movement / instability No weakness Rough / smooth No history of significant injury The pain does not keep the patient awake at night There is no stiffness in the neck No pain on touching the shoulder blades No pain on brushing hair Pain is not worse in the morning No aching in both shoulders or hips No pain associated With sporting activity, including weight training and house work, dressing or other activities Believes able to thorw a ball underhand for 10-20 metres and overhead 20-25m Feels can lift a 2L container level with shoulder Believes can carry a 20-30kg weight by their side Examination: Cervical spine exam is normal Inspection:  The shape and contour or the shoulder joints appears normal Normal posture and position of the scapula No evidence of deformity,swelling or muscle wasting Palpation:  The following joints were palpated: AC Joint ...

Shoulder exam: Look -  No obvious deformity, scars or wasting Feel - No obvious tenderness to palpation over SC joint, clavicle, AC joint, shoulder joint, rotator cuff tendons Move:  Abde to abduct forward shoulder to 180 degrees Abde to abduct shoulder laterally to 180 degrees Gerbers test negative Impingement test negative reassured Keywords:  Shoulder Exam, Normal shoulder exam, Shoulder examination