Physiotherapy Initial

Subjective: SHx: * Works as a software engineer, desk-based job. * Enjoys hiking and cycling on weekends. HOPC: * Fell while hiking 2 weeks ago, landing on outstretched hand. * Immediate pain and swelling in wrist. * Saw GP who suspected sprain. * Pain has gradually improved but still limits activities. Severity: * Worst symptom severity: 7/10 during activity. * Average symptom severity: 3/10 at rest. Irritability: * Symptoms persist for up to 30 minutes after aggravating activity. Nature: * Pain is described as a dull ache with occasional sharp twinges. * Pain is located in the dorsal aspect of the left wrist. Neuro/Red Flags: * No reported neurological symptoms. Improving: * Condition is slowly improving. PRx: * Rest, ice, and over-the-counter pain medication. Aggs: * Wrist extension, gripping, and weight-bearing activities. Activity Limitations: * Unable to do push-ups. * Difficulty typing for extended periods. Eases: * Rest, ice, and elevation. 24/24: * Pain is worst in the morning and after activity. * Pain is minimal at night. Meds: * Ibuprofen as needed. PMHx: * No relevant past injuries. Exercise: * Has access to a gym and some basic equipment at home. * Has prior experience with strength training. Expectations: * Patient expects to regain full wrist function. Goals: * Return to hiking and cycling without pain. * Be able to type comfortably for work. Objective: Observation: * Mild swelling over the dorsal aspect of the left wrist. * No bruising or redness. * No obvious asymmetry. Palpation: * Tenderness to palpation over the scaphoid and distal radius. * No significant tightness noted. * Pain reproduced with palpation of the scaphoid. Functional Tests: * Gait: Normal. * Hopping: Pain-free. * Squatting: Pain-free. AROM: * Wrist flexion: 0-60 degrees, pain at end range (P1). * Wrist extension: 0-45 degrees, pain at end range (P1). * Radial deviation: 0-20 degrees, pain at end range (P1). * Ulnar deviation: 0-30 degrees, pain at end range (P1). PROM: * Wrist flexion: 0-70 degrees. * Wrist extension: 0-50 degrees. * Radial deviation: 0-25 degrees. * Ulnar deviation: 0-35 degrees. Strength/Capacity: * Grip strength: 20 kg (left), 30 kg (right), LSI = 67%, pain score 4/10. Neuro: * SLR: Negative. * Slump: Negative. * ULTT: Negative. Special Tests: * Scaphoid shift test: Positive, pain and clunk. Action: Treatment: * Wrist mobilisations to improve joint mobility. * Soft tissue massage to forearm muscles. * Taping to provide support and reduce pain. // Reassessment: Pain reduced to 2/10. Education: * Importance of activity modification. * Instructions on home exercises. * Explanation of injury and healing process. Exercise Program: * Wrist flexion/extension with light resistance: 3 sets of 10 reps. * Grip strengthening with a stress ball: 3 sets of 10 reps. Plan: Planned progression of activity or load: * Gradual increase in activity levels as tolerated. Next physiotherapy session and focus: * Review progress and adjust treatment plan. * Progress exercises. Short-term goals: * Reduce pain to 0-2/10 at rest. * Improve wrist range of motion. Long-term goals: * Return to full function. * Return to hiking and cycling. Patient-Friendly Summary: Today, we discussed your wrist injury and performed a thorough assessment. We found some tenderness and limited movement, but overall, things are improving. We did some hands-on treatment to help with your pain and movement. For the next session, we'll check how you're doing and adjust your exercises. Keep up with your home exercises, and we'll gradually increase your activity levels. We'll work towards getting you back to your hobbies and work without pain.