1. Sam is a 24-year-old engineering student approaching the final year of final exams. She loves going to the
gym to help with the stress of her studies. Last week, Sam had to move out of her rental apartment in a hurry-
her scholarship was not renewed this year and she was unable to pay rent. She had a friend help her move but
the whole experience has been emotional for her. Sam enjoys mountain biking on the weekends but 2-weeks
ago she hit a tree root and fell off her bike. Sam would love to return to the gym but her arm work outs with free
weights have been too painful since her fall. Sam has a history of Ehlers-Danlos syndrome. She reports
recurrent ankle sprains since high school as well as frequent anterior shoulder dislocations.
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Sam presents to you with:
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P1: pain in the medial side of the right forearm and dorsal wrist that appears to be worsening in intensity.$
She rates this at 7/10 on the NPRS at its worse.$$$
Aggravates/eases: unsure
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P2: a mild ache in the right suboccipital region which she rates at 2/10 on the NPRS.
Aggravates: turning her head from side to side.$
Eases: Lying down
2. Terry is a 56-year-old commercial real estate agent, single mother of 3 teenagers, and carer for her elderly
mother who just had a stroke. Terry travels frequently to building sites and loves her work but finds it very
difficult to balance her home life and still stay competitive at work. Terry has a passion for sustainable living
and learned to harness the power of renewable energy, installed solar panels on her roof, and repurposed
rainwater for her garden. In the last year she has only used a bicycle to get to work, refusing to use a car. Terry
has Type 1 diabetes and uses an insulin pump. Three months ago, she noticed tingling in her right hand and
foot, which she reported to her GP. One month ago, Terry tried to fix the family dishwasher from a video
online. She held her head and neck in an awkward position while using her arms to patch the drain hose for
about 40 mins. Since that time, Terry has been having difficulty cycling to work due to pain.$
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Terry presents to you with a 1-month history of:
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P1: right-sided neck pain and stiffness (2/10 on the NPRS).
Aggravates: swimming and sustained postures such as driving and working at a laptop.
Eases: sitting in a recliner chair with it tipped back.$$
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P2: right anterior shoulder pain (5/10 on the NPRS).
Aggravates: overhead activities and reaching into his back pocket.
Eases: rest.$
3. Tam is a 36-year-old financial analyst and plays hockey 3 times per week with an over 35’s Dad's team. For
many years, Tam has had morning stiffness in the thoracic spine for 20-40 minutes, which improves as he gets
moving. He says the stiffness and discomfort may be worsening as sometimes interrupts his sleep and can affect
his ability to play hockey. Tam lives with his wife and two young daughters who he has inspired to play hockey
on a select team. Tam experiences fatigue, heart palpitations and dizziness which he says are related to long-
Covid. He has had 3 respiratory infections in the last year, one of which landed him in the hospital for 1 week.$
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Tam presents to you with:
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P1: an insidious onset of a left-sided mid-thoracic ache (4/10 on the NPRS) over the last week.$
Aggravates: He is unsure what aggravates these symptoms, although sometimes it can be worse after sitting
a long time or with hockey.$$$
Eases: stretching
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