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Record

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Recording — 04:32
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Case Summary

Presenting

R shoulder impingement, 6-week Hx

Aggravating

Overhead reaching, sleeping on R side

Easing

Rest, ice, pendular exercises

Goals

Return to tennis within 8 weeks

Clinical Guidance

Questions to Clarify

?Clicking only above 140° or through the arc?

?Any history of instability or dislocations?

Differentials

Subacromial impingementLabral tearAC joint pathology
Ask anything about this patient or clinical topic…↑
Live NotesGenerating
SOAP — Physiotherapy

Subjective

Patient reports significant improvement in R shoulder since last visit. Pain at rest reduced from 6/10 to 3/10. Sleep less disrupted. Main concern: persistent clicking at end-range flexion, particularly reaching overhead.

Objective

Active ROM: Flexion 155° (↑ from 130°), Abduction 145° (↑ from 120°). Positive Neer's test. Clicking at 140° flexion. Improved scapular stability. RC power 4+/5 all groups.

Assessment

writing…

Improving R subacromial impingement. ROM and strength gains consistent with expected trajectory. Persistent clicking at 140°

Plan

waiting for assessment…
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Rapid Review
Note 6 of 8
Sarah Mitchell
Mon, Feb 17Follow-up
Draft

Subjective:

Reports significant improvement in right shoulder symptoms. Pain at rest reduced 6/10 → 3/10. Sleep less disrupted. Exercises performed daily.

Objective:

Active ROM: Flexion 155° (↑ from 130°), Abduction 145°. Positive Neer's. Clicking at 140° flexion. RC power 4+/5 all groups.

Assessment:

Improving R subacromial impingement. ROM and strength gains on track. Persistent clicking at 140° warrants investigation.

Plan:

Progress to Phase 2 — graded loading with scapular control focus. GP referral for MRI if clicking persists. Continue 1×/week × 4 weeks.

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Note 7 of 8
James Chen
Mon, Feb 17New
Draft

Subjective:

Woke with acute L neck pain 3 days ago. No trauma. Pain on rotation to left, rated 7/10. No radiculopathy. Paracetamol providing mild relief.

Objective:

Cervical rotation L 35° (R 70°). Palpable hypertonicity L upper trap/levator scap. No neurological deficit UL. AROM Flexion WNL.

Assessment:

Acute L cervical facet dysfunction with associated muscle spasm. No red flags identified. Likely mechanical origin.

Plan:

Gentle AROM exercises, heat, posture education. Trial of manual therapy next session. Review in 3–5 days.

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Note 8 of 8
Priya Sharma
Mon, Feb 17Review
Draft

Subjective:

Continued L lateral epicondylalgia, 8 weeks post-onset. Grip strength improving. No pain at rest, aggravated by wringing, lifting kettle.

Objective:

Pain-free grip 28kg (↑ from 18kg). Tenderness over CEO. Positive Mill's test. Negative neural tension UL. Full ROM elbow.

Assessment:

Resolving L lateral epicondylalgia. Functional improvement consistent with progressive loading program.

Plan:

Continue eccentric wrist extension program. Progress to isotonic loading. Discharge planned at grip ≥35kg pain-free.

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Plan

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Treatment PlanEvidence-Based
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Right Subacromial Impingement Syndrome

Moderate Severity · 10 appointments over 13 weeks

MSK — Shoulder

Subacromial impingement occurs when the rotator cuff tendons are compressed during overhead movements. Most patients achieve full recovery within 3–4 months.

Phase 1

Acute Management

2×/week · 2 weeks

Focus

Pain management, tissue protection, restore early ROM.

Goals

  • •Reduce pain to ≤3/10 at rest
  • •Restore 80% passive ROM

Interventions

  • •Manual therapy
  • •Ice/heat modalities
  • •Gentle ROM exercises
Phase 2

Progressive Loading

1×/week · 4 weeks

Focus

Graded strengthening, neuromuscular control, return to function.

Goals

  • •Full active ROM without pain
  • •90%+ strength vs contralateral

Interventions

  • •Eccentric loading
  • •Proprioception drills
  • •Functional patterns
Phase 3Return to Activity· 2 appointments
3 references·Safety disclaimer
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Generate

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GP Referral Letter

Generated
BIUH1H2

17 February 2025

Dr. James Carter

Northern Beaches Medical Centre

RE: Sarah Mitchell — R Shoulder Management

Dear Dr. Carter,

Thank you for the ongoing co-management of Sarah. ROM has improved to 155° flexion (from 130°). Persistent clicking at 140° warrants consideration of imaging to exclude labral pathology.

I would appreciate your consideration of an MRI referral.

RegenerateCopyPDF
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WorkCover NSW5/6 filled

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Form 032 — Provider Management Plan1/1

PROVIDER MANAGEMENT PLAN

Workers Compensation — Form 032

SIRA

Worker's Name

Sarah Mitchell

DOB

14/03/1988

Diagnosis

R shoulder — subacromial impingement

Claim Number

WC-2025-48291

Date of Injury

06/01/2025

Treatment Plan

InterventionItemQty
Manual therapy & mobilisation1056
Exercise prescription1336
RTW functional assessment4002

Practitioner Signature

Date

17/02/2025

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Exercise

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Exercise Programs
Clinician ViewPatient View
Shoulder Rehab — Phase 2Active

Wall Slides

3 × 12 · Mobility

External Rotation

3 × 15 · Strength

Scapular Squeezes

3 × 10 · Stability

Pendulums

2 min · Mobility

Clinician Tip

Focus on keeping your shoulder blade pinned back during external rotations. Stop if you feel pinching at the front.

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Patient App

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9:41

Good morning, Sarah 👋

Coastal Physiotherapy

Next Appointment · in 2 days

Tuesday, 4 March

10:30 AM · Dr. Williams · Follow-Up

RescheduleView Details
Treatment Plan

R shoulder impingement — Phase 2

4 of 8 sessions50%
Today's Exercises3 remaining
Wall SlidesDone
Shoulder External Rotation
Scapular Squeezes
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Mentor

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Clinical MentorActive Session
SummaryFollow-up
AW

Sarah still has clicking at 140° flexion — should I be concerned about labral involvement? What tests should I prioritise?

Good clinical question. Clicking at 140° with an impingement presentation raises the differential of a superior labral tear (SLAP). Key tests to prioritise:

1.O'Brien's test — most sensitive for superior labral tears [1]

2.Dynamic shear (crank) test — targets posterior labrum [2]

3.Speed's test — biceps/labral junction involvement

If 2+ tests positive, consider MRA referral given the 6-week timeframe.

Hegedus et al. 2012Meserve et al. 2009
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←Today→Book
2 waitlist matches foundDr. Chen has a cancellation at 3:30pm
View Matches
AWDr. Williams
4 appointments
8:00· 60min

Sarah Mitchell

Initial Assessment

Confirmed
9:30· 30min

James Chen

Follow-Up

Checked InNotes
10:30· 45min

Priya Sharma

Review

ConfirmedPlan
14:00· 30min

Tom Bradley

Dry Needling

Confirmed
LCDr. Chen
5 appointments
8:30· 60min

Emma Watson

Initial Assessment

In Session
10:00· 45min

Liam Park

Post-Op Review

ConfirmedPlan
11:30· 30min

Olivia Chen

Follow-Up

Online Booking🌐 Online
14:00· 30min

Noah Taylor

Dry Needling

ConfirmedNotesPlan
15:30· 30min

Mia Johnson

Exercise Review

Confirmed
MPDr. Patel
3 appointments
8:00· 60min

Ethan Brown

Initial Assessment

Confirmed
9:30· 30min

Ava Williams

Follow-Up

ConfirmedPlan
11:00· 45min

Lucas Davis

WorkCover Review

ConfirmedNotes
Cliniko Synced
·
Online Booking Active
·
Waitlist: 4 patients
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Pending

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Failed

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342

sent

99.1%

delivery

24h Reminder

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289

sent

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delivery

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Email

156

sent

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delivery

No-Show Follow-Up

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23

sent

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sent

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Today's Tasks8 remaining
+ Add Task

Sophie R. wants Tue/Thu PM with Dr. Chen — a slot just opened!

Notify

Call Sarah M. re: MRI results

Sarah Mitchell

CallJW

Book follow-up — shoulder review

David Chen

BookingKL

Reply to WorkCover enquiry

Alex K.

EmailJW

Order kinesiology tape

StockKL

Chase invoice #2847

Northern Physio

InvoiceJW

Confirm Wed appointments

Task
2/8 done
Bulk RescheduleWaitlist

Repeat Weekly Booking

Dr. Williams · Follow-Up (30 min) via Cliniko

5 available1 conflict1 skipped

Week 1

Mon 10 Mar

2:30 PMAvailable

Week 2

Mon 17 Mar

2:30 PMAvailable

Week 3

Mon 24 Mar

2:30 PMConflict

Week 4

Mon 31 Mar

2:30 PMAvailable

Week 5

Mon 7 Apr

2:30 PMAvailable

Week 6

Mon 14 Apr

—Skipped

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4 patients waiting

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2 matches found — cancellations freed slots matching waitlisted preferences

SR
Sophie RobertsMATCHED
Dr. ChenTue, ThuAfter 2 PM

→ Thu 3:30 PM slot available

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David MartinezMATCHED
AnyMon, WedMorning

→ Wed 9:00 AM slot available

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LT
Lisa Thompson
Dr. WilliamsFriAny time
TB
Tom Baker
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Added 24 Feb

Track

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Clinic Dashboard
Last 30 daysExport

Total Plans

124

+18%

Booking Rate

76%

+4.2%

Plan Completion

82%

+6%

Cancellation Rate

8%

−2%

Weekly Trend

Plans Bookings
Wk 1
Wk 2
Wk 3
Wk 4

Team Leaderboard

1
SW

Dr. Sarah W.

42 patients
94%
2
JC

Dr. James C.

38 patients
88%
3
ML

Dr. Mei L.

31 patients
91%
4
TB

Dr. Tom B.

27 patients
85%

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Dr Priya Sharma

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