Patient Examples

 1. A 45 year old healthy woman underwent a successful metatarsal osteotomy for treatment of a bunion on the right foot. On review at 4 weeks, she complains about high intensity burning pain and sensitivity throughout her foot. The x-ray shows a good position with no metalwork concerns and no signs of infection and there is mild localised osteoporosis around the MTPJ. On gentle examination – the patient does not like anyone handling her foot. There is a mild mottled blueish discolouration throughout the foot, which also feels colder than the other. Treatment focused on desensitisation, mirror visual feedback & functional rehabililtation

2. A 60 year old fit and healthy man at 5 weeks post distal radius fracture in fracture clinic. He reports having felt “claustrophobic” in the cast from day 1 and have had the plaster changed on 3 occasions having presented to the Emergency Department between fracture clinic appointments. The cast has been removed and the patient has disproportionate pain, allodynia to light touch throughout the hand and cannot make a full fist. There are no temperature or colour changes and the patient withdraws the hand every time you approach him. Treatment initially focussed on desensitisation and Mirror Visual feedback (MVF).

3. A patient presents with a 3 year history of pain swelling and severe loss of movement in their hand following a fall on an outstretched arm with no identifiable fracture or tissue damage. They describe their hand as large and ugly and can not tolerate looking at it. On observation the hand is only slightly swollen but discoloured and the patient can not comfortably be touched. They have a diagnosis of CRPS but report all previous treatment has made their pain unbearable. Treatment included pain education, laterality training, MVF , desenstisation and pacing.

4. Patient unable to put a shoe on their foot after removal of plaster. When asked why, the patient stated her foot was far too large for the shoe even though visually the swelling present was minimal. Patient perceived the foot to be twice the size of the contralateral limb. Treatment focussed on Neglect features and included body perception re-education, and MVF.

5. Patient became anxious when approaching arm and when questioned she explained that her arm seemed huge and was expecting painful contact as soon as therapist moved towards her. Treatment included desensitisation, body perception re-education and MVF.