The Importance of Shadowing Sessions

As an Advanced Physiotherapy Practitioner working in an Orthopaedic Shoulder and Elbow Service, seeing re-routed referrals to the Orthopaedic Surgeons, I cannot stress enough how interesting it is to shadow other members of your team.

Over a two day period, I shadowed a Consultant Rheumatologist and a Consultant Radiologist and my learnings have been exponential!

Inflammatory Arthropathy

Reviewing all the diagnosed inflammatory arthropathy patients was so interesting. Sometimes, due to their age, it was hard to ascertain whether their current symptoms were due to their inflammatory arthropathy or degenerative arthropathy, or perhaps a bit of both.

Important clinical symptoms and signs to look for when considering a new diagnosis of inflammatory arthritis are; swelling of the joints, tenderness around the joints, synovitis of the joints (particularly around the wrist and hand and foot and ankle), along with morning stiffness. Consider doing a DAS28 (disability assessment score). 28 refers to the number of joints assessed, and it is a measure of disease activity if you are considering inflammatory arthritis as a diagnosis/differential diagnosis.

I also learned the importance of newly diagnosed inflammatory arthritis patients starting on disease-modifying drugs as soon as possible. This is to prevent joint destruction. However, some patients do not tolerate these (or have no benefit from their symptoms) so need anti-TNF therapy or biologic therapy. All these drugs come with some side effects that patients can find hard to tolerate, and it can be really challenging to get the medication ‘right’.

So many things to consider with inflammatory arthritis. I also learned about palindromic arthritis, more common in the younger population and behaves a little like gout-look it up!

Radiology

I had the opportunity to watch some interventional radiology and image reporting. 

Watching an image-guided subacromial injection was so interesting, after identifying a thickened subacromial/subdeltoid bursa on ultrasound, it was injected and the inflation of the bursa with the injection was easily captured on screen. So having seen a deflated structure being ‘inflated’ I then watched an inflated structure (Morel-Lavallee lesion) be aspirated/deflated, with over 80mls of fluid removed.

Next was a lypoma on a buttock and finally a trigger thumb which clearly showed the tendon of Flexor Pollicis Longus getting stuck in the A1 pulley.

Image Reporting

I had the amazing fortune of looking at MSK MRs with the Radiologist. So interesting, the more information we can give them when requesting the scan the better, for example, ‘what are we suspecting clinically? what would we like them to rule out?’

A lumbar spine MR, requested by orthopaedics, for back pain, proved to be very interesting.  Immediately the Radiologist noticed a large lesion in the kidney (6x10cm), it was thought to be ‘suspicious’ and an urgent CT scan was requested. A shoulder MR was less eventful, as was one of a foot of a patient with rheumatoid arthritis, but it did challenge my anatomy!

I cannot tell you how much I learned over 48 hours, not least about the hard work of other members of our team. It has been invaluable and I challenge you to shadow too. I’ve already booked my next shadowing sessions.

Happy learning!

Emily Goodlad
Module Coordinator, SOMM

Also worth reading: 

Physiotherapy for Elite Athletes versus the General Public

Read here

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