P4R3W2: Outpatient Physiotherapy

I began my third placement, musculoskeletal (MSK) physiotherapy, in Nelson Hospital's Outpatient Clinic this week. The Outpatient Clinic typically receives clients referred from their General Practitioners (GPs). Clients tend to have: age-related diseases (arthritis) and follow up physiotherapy after orthopaedic surgery (hip / knee replacement)... but there are a whole range of cases. My week was a mixture of shadowing my supervisor and seeing my own clients. After a subjective assessment I would find my supervisor and give a handover - we would then have a quick chat about the objective assessment and the likely treatments. I saw three total knee replacement follow-ups at around the three week post-surgery mark. Although the patient cases were seemingly the same (...how different could three people who have had a knee replacement be?), I didn't offer a recipe-like approach at all. There were a range of differing presentations: different stages of wound healing, knee clunking in one case, stiffness/pain (or no stiffness/pain) and differing levels of compliance to their recovery plan.

Examples of less typical cases in the Outpatient setting this week included postural habits causing functional changes, reported frequent subluxation of a shoulder joint and  an (almost) unhappy triad (knee ligament MCL, ACL and PCL reconstruction).

The Outpatient Clinic is funded by the public health organisation, and so it is free for clients who have a referral. This is particularly great for those who are financially constrained. Physiotherapists at the Outpatient Clinic offer a range of group classes including a knee circuit training class and hydrotherapy class. I referred two clients to the hydrotherapy class and was able to guide them through their first pool session.

The images below are of my desk, my treatment cubicle and the Outpatient Gym!

The Emergency Department at Nelson hospital has Allied Health, physiotherapy and social work, services. It is one of the few hospitals in New Zealand that has a full time emergency department physiotherapist. I'll elaborate on this in future posts, but in the meantime have a read of this article:

Holmes C, Hollebon D, Scranney A, Exton H (2016) Embedding an Allied Health Service in the Nelson Hospital Emergency Department: a retrospective report of a six month pilot project. New Zealand Journal of Physiotherapy 44(1): 17-25. doi: 10.15619/NZJP/44.1.03

I am lucky to have Friday in the Emergency Department (ED). It is said that Friday is a busy day because people choose to come / 'get sorted' before the weekend. That wasn't the case this week... not between 8:30am and 4pm anyway - they probably came in after they had finished work. I was shadowing this week, however over the course of the placement I will attend to my own cases with the supervision of a physiotherapist. I saw two people with a calf injury and two people with a hand injury - the first of each injury location was the least severe. There were two highlights of the day, the first was physically assisting the reduction of a fracture i.e. closing the fracture, to straighten the bone / reposition it back as it would normally be. It was of the 5th proximal phalanx (little finger). Whilst I stabilised the proximal head, the doctor used a pen as a fulcrum and pivoted the bone back into place - the patient had local anaesthetic (as you would expect). The x-ray following the reduction looked as if no fracture had occurred. My second highlight followed on from this with the same patient. The physiotherapist took this patient to have a plastic cast / splint made. The patient was taken up to the hand therapy clinic on 5th floor (Outpatient clinic area) and had thermoplastic moulded and cut to support the hand/fingers.

In the weekend I went to find the Emerald Pools, inland following the Pelorus river (turn off and follow Maungatapu road by the Pelorus bridge). I've noted a series of huts, the first hut being 4h from the car-park (3h from Emerald Pools) that will be attempted some time this year. I think the Emerald pools may look their best in the summer with proper sunshine into the valley. The gravel road to the car-park was well maintained (very few potholes - I was pleased about this).