WEEK 3- 2nd Entry

Situation
In my third week of my placement I was given a referral for a 25year old male who had been referred by the occupational therapist in Broome Health Campus. The occupational therapist suspected tendonitis of the digiti minimi tendon in his left hand. He had been having a deep ache in his left hand for over 1 week. His past medical history included a previous fracture to his left scaphoid bone that was internally fixed 10 years ago, a left collar bone fracture over 5 years ago and gall stones which he has due to hav skin impedance and make it more difficult for the electronic treatment device to have the desired effect. e removed in two weeks.
His occupation was a pilot, and he was finding that he was experiencing increasing amounts of pain in his hand when he was flying the planes on longer journeys. I introduced myself and I asked him to come through to the treatment room with me and I performed a subjective and objective assessment. I found that he had pain at the end of range of pronation and wrist flexion, tenderness on palpation of his digiti minimi tendon and weakness on 5th finger extension when the left finger was compared to the right finger.

Task
I was asked to assess and treat this man with possible tendonitis of the digiti minimi tendon.

Action
In the treatment session I did the following;
- Firstly I performed deep tissue massage to his digiti minimi tendon with transverse tendon friction.
- I then performed ultrasound to his digiti minimi tendon.
- I advised him to wear his resting brace as much as possible during the next two weeks.
- I educated him about tendonitis, the pathology of the condition and its approximate healing time.
- I also informed him about taking anti-inflammatory medication (such as Neurophen) and its role in helping decrease the pain in tendonitis.

Result
The result was I effectively treated this man for 40 minutes, identifying his astrics signs and using the mentioned methods to address his problem list.

Evaluation
I think the treatment session went ok, I did identify that this man was in his acute phase of tendonitis, and I effectively treated the pathology and addressed his pain management.
However, I think I should have progressed this man earlier on, I think I should have given him strengthening exercises ( eccentric) within a pain free range as he was young and only mildly irritable. Originally I was going to give him the strengthening exercises on his next visit, however on reflection I think it would have been more effective to give them earlier on.I think I should have though about what order I performed my treatment in; before I administered it. I think I should have performed my education first, then my ultrasound, then my deep tissue massage with transverse tendon frictions. This would have made the treatment session flow better, in addition it would have prevented the problem of increased skin impedance with the electronic device (due to the cream used in the massage).

Strategies
I think I could defiantly improve my treatment of this individual next time if I took into consideration the following points;
- Always check how effective my treatment has been by assessing the astricks signs after one repetition of treatment. This makes me more aware if my treatment was effective and what part of my combination of treatment yielded the most results/progress.
- Use diagrams to help explain to the patient how the intervention/ treatment can be effective
- Start progressing the individual early on in the intervention; even if treating an acute problem sometimes its appropriate to give them exercises earlier on (depending on their irritability level). Don’t wait for the next treatment session to start progressing them.
- If using ultrasound and also massaging, consider using the ultrasound or electrical device first in the treatment session. The reason for this being that having things like oil or cream on the skin can add to skin impedance and make it more difficult for the electronic treatment device to have the desired effect.