This is a case-based Essay(1500 words)
(use an academic language as a physiotherapist)
Introduction: Summarise the case. definition- the important thing(reason)eg. decrease the pain , increase normal hip function. Look at physical processes OA + Structures of THR involved in the case
The Anatomy in this case has to be short it is not very important.
What we can do to help her.
The essay should discuss the structures in terms of PATHOLOGY (bone, muscle, ligaments etc.)
· Describe the main physical processes and the structures involved in this case · Identify the key biopsychosocial factors that may influence the patient’s experience of this problem.
eg. Biopsychological(how these effect management): Social History: Husband who has Parkinson’s disease, flat 1st floor, cats, daughter + grandchildren
Management – Social Services, MDT
· Discuss how consideration of these factors that may influence the management and outcome (what is necessary for a good outcome eg. Rest, posture) of the case · Include a full reference a list 2) Annotated Reference · Select five reference from your reference list that were key to your essay · For each of those five, provide a 200 word summary (in total 1000 words of annotated reference)
Case 1500 words+ reference 1000words = 2500 words
Hip joint replacement
PERSONAL BACKGROUND
Mrs Vera Chatsworth is a newly retired 65 year old female. She lives with her husband who has Parkinson’s disease which limits his mobility and requires the use of a wheelchair outside which needs to be pushed. They live in a 1st floor flat, which has no lift.
Their daughter, Tracy, lives 5 miles away and is currently able to visit daily to help with shopping and caring for her father. Tracy is married with 2 children, which means that she will not be able to help out as much when the school holidays end in two weeks. Mrs Chatsworth is worried that she is going to be a burden on here daughter and that she would like to do as much as possible for herself, while she still can. The elderly couple have two cats called Jasper and Shamus; they love their cats and claim that they keep them company on the days when they can’t get out and about.
Mrs Chatsworth has been unable walk any distance (more than 10 minutes) for past year and before the operation the pain was preventing her sleeping.
HISTORY OF PRESENT CONDITION
Successful total right hip joint replacement 6/52 ago; Posterolateral approach.
Good post-op recovery in spite of the large post-op haematoma. She was discharged home in 10 days. At discharge there remained a significant loss of ipsilateral knee ROM that was possibly due to the soft tissue swelling in the thigh.
She is independently mobile PWB on elbow crutches, but has been referred for physiotherapy due to lack of full ROM in ipsilateral knee
PAST MEDICAL HISTORY
High blood pressure
Osteoarthritic changes in hips, knees and shoulders.
For the past 5 years she has had severe right hip pain. Very painful and stiff in the mornings, usually eases slowly with light activity and warm baths. Worsens after walking 10 -15 minutes. Cannot sit in low chairs or climb stairs easily.
Now she is sleeping well and pain is significantly reduced but her right hip and knee are still both very stiff and she is reluctant to trust her right leg for FWB.
MEDICATION
Atenalol
Analgesia as needed
OBJECTIVE ASSESSMENT
Observation:
Healed wound with residual thigh and knee joint swelling
Gait:
PWB with elbow crutches with a slightly flexed knee.
Strength
She has no apparent loss of strength on her left side although you notice that she does not have much muscle definition or bulk in her right or left quadriceps and a marked reduction of her right gluteal muscle bulk compared to her left. All active hip movements in standing are pain free on the left, but repeated or manually resisted movements of her right hip are uncomfortable. This is not a sharp pain, but more a dull ache in the hip and thigh which fades quickly with rest. Resisted knee extension in sitting also causes a dull ache but resisted knee flexion at end of range is not a problem.
Hip Active ROM Passive ROM
R L R L
Flex 80° 100° 90° stiff 110°
Ext -10° -10° -10° OK -10°
Abd 40° 40° 40° 40°
Add Limited by post operative care guidelines
Int Rot Limited by post operative care guidelines
Knee Active ROM Passive ROM
R L R L
Flex 80° * 130° 90° * 130°
Ext -15° 0° -5° stiff 0°
* = pain at end of range
Credit:ivythesis.typepad.com
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