0830am - 1030am
PWH adult Orthopaedic Ward D
The old Popo we dealed with on Thurs was still in hospital and we were more than happy. (Our previous patients always get discharges after our one day of rehabilitation) After our routine subjective and objective examination, we taught our PoPo to work on her quads and to walk with quadripod for the first time. She was indeed co-operative and nice. We chatted along the way and she told me her whole life-story. (her huby was once in airforce and how their friends were killed by the commnist's bomb etc etc) CE Patrick was as funny and educative as ever! We learn to test the lady's walking and turning skills without her knowing and at the mean time, enjoy the chat. As a therapist, I fully understand the need to "get things done" instead of just "accompany the patient". I am beginning to be more skillful each day under the guidances of our dear CEs. I am too starting to get use to reading the bed notes and writing them. It's not an easy job to stifle out 5cm thick and over of notes -- for now, I can do it in 10 minutes (gotta be faster the next time) :).
I seriously like CE Patrick, he makes my day more fulfilling and fun. :D I learnt and not just "study" a lot recently. The way to stretch, the concerns for strengthening, the differentiation between stiffness of different kind.... ... It was a totally hands on. This is reality.
1100am-1230pm
PWH Paediatric Ward
I was given a new case-study today. A 9 years old girl clinically admitted to the hospital for bilateral supramalleolar osteotomy for tibial internal rotation. She suffered from a in-toeing gait -- often tripping over herself. A right and left derotation of both of her tibia and fibua was done and she was put in a sarmiento cast. In 1998 she suffered from spiina bifida with myelomening. ocele (脊髓脊膜膨出) and had a operation then.
Our job: Improve her mobility. :D
0130pm-0330pm
Outpatient hand-class
Here, I saw loads of cases and got a feel of the HK physio department "high peak season" or "50+ patients in a day". The followings present to you the cases that were of absurd interest to me. :D Looking at X-ray is real intriguing too actually. :P
CASE 01 - TRIGGER HAND
O/E: Conditions improved. Pain+ on Flx. Swelling+.
http://www.handsurgeon.com/trigger.html
http://www.eorthopod.com/public/patient_education/6552/trigger_finger_and_trigger_thumb.html
CASE 02 - # Distal of Radius (1.5 mths post-op)
ORIF. Plating done.
O/E: Extensors atrophy. Stiffness at R/C joint.
Rx: Passive stretch extensor, R/C Mobolisation ex, ES extensor, Strengtheing flexors,scar mobolisation (radial side approach)
http://www.davidlnelson.md/Wrist_Fracture.htm
CASE 03 - # 1st metacarpal (3moths post-op)
Bone graft from the left iliac crest due to the complte destruction of the bones by a flour blending machine. It was actually written as "flower" in the case note. :P There was also poor coverage of periosteum and adjacent sof tissue.
O/E: Decrease in thumb abd/add (webspace)
http://www.learningradiology.com/notes/bonenotes/wristfxs.htm
http://www.uptodate.com/patients/content/topic.do?topicKey=ad_orth/12503
CASE 04 - Ulnar nerve palsy
O/E:
Typical claw hand.
Hypothenar/interossei atrophy
Inability to oppose the last 2 fingers
Inability to pinch a paper
Decrease in abd/add strength of hand
http://www.doctorslounge.com/neurology/diseases/ulnar_palsy.htm
CASE 05- Erb's Palsy
14 years old boy
O/E: Inability to raise arm above SH level
http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe00216.htm
CASE 06 - Thenar degeneration/ Insatbility at CMCJ
The surgeon did a very innovative surgery. He used the tendon of the FCR to curl around the CMCJ joint in order to stabilise it.
http://www.wrongdiagnosis.com/sym/muscle_symptoms.htm
It was mid-term feedback in the afternoon. Mine was considered good. :) The CE said that I have had a high expectation for myself. oh well. Much more room for improvement thought.
Evening.
Met up with Shi qi from SG and we had grest fun shopping and watching the laser show at Avenue of stars.
The beautiful nightsky.
Performance in the streets of Mongkok @ 0000
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