Full Clinical Review

What is a Full Clinical Review?

Dr Samra specialises in difficult-to-diagnose and difficult-to-treat muscle and joint problems.

A Full Clinical Review provides further information on which to base further investigation.

As the medical specialists in the field, we are the doctors that other clinicians refer their most difficult cases to for assessment.

If you have soft tissue or joint pain that has been difficult to diagnose or has not completely responded to treatments you’ve been offered in the past, you should talk to your GP or Physiotherapist to consider Specialist consultation.

Sport and Exercise Physicians have specialist-level training and extensive experience to narrow down a diagnosis for even the most difficult and unusual conditions. You do not need to be an elite athlete to see a Sport and Exercise Physician!

Some patients have had a variety of scans that have been reported as being normal.

Dr Samra will think deeply about your problem to provide a rational explanation of your symptoms. He utilises point-of-care ultrasound which is very useful for diagnosing disorders that only occur dynamically during activity, or in certain positions.

The review includes a physical exam of your general health with a specific focus on your general health’s impact on musculoskeletal performance, and vice versa.

The purpose of a Full Clinical Review is to:

Examine your Joint, Tendon, Muscle or Bursa for problems
Identify any functional deficits of strength, range of motion, balance or coordination
Evaluate your Biomechanics and Gait
Review your Lifestyle with regards to exercise, diet, sleep, mental health, men's and women's' health
Consider movement and aging issues

The review is individualised based on the patients

Personal history and type, and
Contextual objectives and stage.

Benefits of a Full Clinical Review

Musculoskeletal pain easily the most common patients see their doctor. By the time we get to 50, our musculoskeletal system has performed many millions of loading cycles. It is also often the first body system to manifest signs of metabolic diseases such as pre-diabetes and diabetes.

A Full Clinical Review conducted by a Sport and Exercise Physician can detect issues early or help manage and resolve issues before they get worse.

This is often conducted as a pre-participation Medical Evaluation for elite athletes, but the same principles can be used to optimise lifestyle choices and health in every day people.

So, having a Clinical Review is an important part of body maintenance and can work as part of a:

Health planning process, and as
An early detection for any musculoskeletal issues.

What to Expect from a Full Clinical Review

Full Medical History

The first step is to take a full medical history. This would include questions around:

General health and relevant medical history
Any sports participation, activities and Goals
Lifestyle: Diet, Mental health, Sleep and Exercise
Associated concerns
Current symptoms

Where there is a specific health issue, further questions include:

What prevention or lifestyle modifications have been required
Movement and activity restrictions
Aggravating factors

Physical Examination

The physical examination should establish the nature and site of any abnormalities found either on visual inspection or palpation.

Dr Samra utilises high-resolution dynamic ultrasound to visualise regions of pain or pathology.

A thorough Musculoskeletal and Systemic examination are always performed together.

As part of a Musculoskeletal examination your Joint range of motion, strength, functional movements, biomechanics and gait would be examined. The doctor may perform a focused examination to evaluate any affected part of the body to determine the presence of swelling, a limited range of motion, muscle wasting and asymmetrical or abnormal movement patterns. Dr Samra will measure joint range of motion and strength if necessary.

The Systemic examination involves a careful inspection for features of disease such as hyperinsulinemia, or eye-signs of high cholesterol or inflammatory disease. Dr Samra will m easure BMI, waist circumference, weight, blood Ketones and Blood Pressure.

Medical Imaging

After the physical examination and you may require medical imaging such as:

X-Ray,
CT-Scan,
Ultrasound, or
Magnetic Resonance Imaging (MRI)

to help rule out or confirm a specific condition and support the clinical examination.

A comprehensive evaluation will help your doctor eliminate various possibilities, arrive at a diagnosis, and recommend a treatment plan.

Further Assessments

Depending on the initial Clinical Review your doctor may ask for further assessments.

This may include:
Relevant Blood Tests
Nutritional assessment- including 3 day food diary and often dietitian review
Psychologist review- with sub-specialist scope to match the patient
Body composition and DXA scanning for Bone Mineral Density
Sleep study or Respiratory testing (Spirometry)
Allergy/Immunology studies
Baseline fitness testing (VO2 max or Wingate testing)
Baseline concussion testing (using the CCMI accredited panel and neurocognitive testing)
Specialist referral as indicated (such as Endocrinologist, Bariatric Surgeon, Orthopaedic Surgeon etc)

What Happens if an Abnormality is Found

At the end of a review and subject to further tests, your doctor will talk to you about anything that is found and let you know if further diagnostic tests are required.

This initial summary typically followed by a detailed Clinical Review Report. This report is a critical form of communication with all parties involved in recovery and it outlines: