Hand Therapy Review Appointment

Subjective: - Presenting Complaint: Persistent pain and stiffness in the left wrist following a distal radius fracture, limiting daily activities. - Client's Goals: To regain full range of motion and strength in the left wrist to return to gardening and knitting without discomfort. - Patient Progress/Problems/Wins. Review Goals/Expectations: Patient reports a 20% improvement in pain since the last session, now rating it 4/10 at worst. She is consistently performing her home exercise programme (HEP) twice daily. She has successfully managed to hold a lightweight teacup without pain. However, she still experiences difficulty with twisting movements, such as opening jars. Duration of pain is constant during activity, intensity fluctuates from 2-4/10. No specialist involvement at this time. - Functional Status: Able to perform light activities of daily living with some modification. Unable to lift heavy objects or perform sustained grasping tasks. Difficulty with supination and pronation movements, impacting tasks like turning doorknobs. Objective: - Physical Examination: Inspection revealed mild swelling dorsally over the left wrist. Palpation noted tenderness over the dorsal aspect of the scaphoid. Good posture maintained. Mobility of shoulder and elbow within normal limits. Muscle strength of biceps and triceps 5/5 bilaterally. Forearm pronation and supination reduced by 30% compared to the right side. - Assessment Findings: - Range of Motion (left wrist): Flexion 40 degrees (normal 80), Extension 35 degrees (normal 70), Radial Deviation 10 degrees (normal 20), Ulnar Deviation 25 degrees (normal 30). - Grip Strength (Jamar dynamometer): Left hand 15 kg (right hand 28 kg). - Pinch Strength: Left tip pinch 2 kg (right 4 kg). - Oedema: Circumference at wrist crease Left: 18 cm, Right: 17 cm. - Pain: Visual Analogue Scale (VAS) 4/10 during active range of motion, 2/10 at rest. Assessment: - Clinical Impression: Residual stiffness, pain, and weakness in the left wrist consistent with post-fracture recovery, impacting functional independence. Improved compliance with HEP and mild progress noted in pain reduction and grip strength. Treatment - Provided manual therapy to left wrist including gentle mobilisations for carpal bones and distal radio-ulnar joint. - Performed soft tissue massage to forearm extensors and flexors. - Reviewed and progressed home exercise programme to include eccentric wrist extension exercises. - Provided education on joint protection principles and ergonomic modifications for household tasks. - Practiced functional tasks such as opening and closing a jar with therapist assistance. - Client's Response: Client reported reduced stiffness immediately post-mobilisation. Demonstrated good understanding of new exercises and enthusiastically participated in functional tasks, reporting a 1-point decrease in pain during the jar-opening exercise by the end of the session. Plan: - Home Programme Recommendations: - Continue current HEP twice daily. - Introduce eccentric wrist extension exercises (3 sets of 10 repetitions). - Continue gentle stretching into pronation/supination. - Referrals: No new referrals made at this time. - Specialist or GP appointments: Attending follow-up with "Dr. Thomas Kelly", orthopaedic specialist, on 15 November 2024. - Follow-Up: Review appointment scheduled for 8 November 2024. - Future Treatment Plan: Continue with current treatment approach focusing on increasing wrist range of motion and strength. Aim to progress to heavier resistance exercises and return to specific leisure activities (gardening/knitting) over the next 4-6 weeks.