Case Presentation Like a Pro

Turn complex patient stories into clear, confident, evidence-based presentations that earn respect and drive better care.

Intermediate · 12 chapters · 144 MCQs · 144 flashcards · Audiobook · Illustrated

Case Presentation Like a Pro teaches physiotherapists and students how to organize, deliver, and defend a clinical case from first contact to discharge. You will learn to structure subjective and objective findings, justify clinical reasoning, present interventions with evidence, and communicate outcomes with precision in ward rounds, MDT meetings, viva exams, and conferences. By the end, you will present with the clarity, confidence, and professionalism expected of a clinical expert.

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What you'll learn

  1. Chapter 1: Foundations of Clinical Case Presentation: Purpose, Audiences, and Formats

    Clinical case presentation is how physiotherapists turn a patient encounter into shared reasoning. A good presentation tells a colleague, examiner, or funder what the patient has, why you think so, what you did, and what happened.

  2. Chapter 2: Structuring the Case: Frameworks, Flow, and the One-Minute Summary

    A case presentation succeeds or fails on structure. Clinicians who present well do not simply recall more facts; they arrange facts so the listener can follow the reasoning from mechanism to decision.

  3. Chapter 3: Clinical Reasoning Made Visible: Hypothesis Generation and Decision-Making

  4. Chapter 4: Presenting the Subjective Examination: History, Red Flags, and Psychosocial Factors

    The subjective examination is the foundation of every physiotherapy assessment. It establishes the working diagnosis, identifies patients who need urgent medical referral, and reveals the beliefs, fears, and social context that will shape…

  5. Chapter 5: Presenting the Objective Assessment: Findings, Special Tests, and Outcome Measures

    The objective section is where your clinical reasoning becomes visible. A reader should be able to see what you measured, how you measured it, what you expected, and whether the result changes your plan.

  6. Chapter 6: Synthesizing Findings: Problem Lists, Diagnosis, Prognosis, and SMART Goals

  7. Chapter 7: Presenting Interventions: Rationale, Dosage, and Progression

    Assessment findings matter only when they lead to a defensible plan. In this chapter you will learn how to present an intervention in a case discussion so that the rationale, dose, and progression criteria are explicit and traceable to the…

  8. Chapter 8: Integrating Evidence: Appraising and Citing Research to Support Your Case

  9. Chapter 9: Visual and Verbal Delivery: Slides, Videos, Body Language, and Handling Questions

  10. Chapter 10: Complex and Special Situations: Multimorbidity, Neurological, Pediatric, Geriatric, and Critical Care Cases

  11. Chapter 11: Ethics, Consent, and Interprofessional Communication in Case Presentations

  12. Chapter 12: Demonstrating Functional Outcomes: Reassessment, Reflection, and Presenting Results with Impact

Free chapter

Chapter 1: Foundations of Clinical Case Presentation: Purpose, Audiences, and Formats

Clinical case presentation is how physiotherapists turn a patient encounter into shared reasoning. A good presentation tells a colleague, examiner, or funder what the patient has, why you think so, what you did, and what happened. This chapter introduces the core purpose, audiences, and formats of case presentation, using a single worked example throughout: a 54-year-old carpenter with subacromial shoulder pain.

Pathophysiology of the Worked Example

Subacromial pain syndrome describes shoulder pain arising from the subacromial space, where the supraspinatus tendon, subacromial bursa, and long head of biceps pass beneath the coracoacromial arch. Pain typically follows repeated overhead loading, and the mechanism is usually a mix of extrinsic compression and intrinsic tendon degeneration. Neer (1983) described external impingement from the acromion and coracoacromial ligament, while Hawkins and Kennedy (1980) described the impingement test that bears their names. Tendon overload produces reactive tendinopathy, then degenerative change, and eventually a possible partial or full-thickness tear in older adults.

For your presentation, the pathophysiology must explain the presenting features. In this patient, pain is worst in the 60–120° elevation arc (the painful arc), night pain occurs on lying on the affected side, and load tolerance is poor in overhead work. Each finding should connect to a plausible mechanism rather than appearing as an isolated list of signs.

Presenting the Case: Purpose and Audience

The primary purpose of a case presentation is clinical reasoning made visible. A written note records what was done. A presentation explains why, and it must be structured so that the listener can test your reasoning. Three audiences are common in physiotherapy:

Peers and clinical teams need concise hypotheses, a working diagnosis and the plan for the next review. Funders need functional goals and outcome measures.

Peers and clinical teams need concise hypotheses, a working diagnosis and the plan for the next review. Funders need functional goals and outcome measures.

  • Peers and clinical teams need concise hypotheses, working diagnosis, and the plan for the next review.
  • Students and educators need the reasoning chain, including differentials considered and rejected.
  • Funders, insurers, and referrers need functional goals, outcome measures, and justification for the episode length.

The same case is therefore presented differently to each group. For a peer team, you might say: "Subacromial pain with a probable rotator cuff involvement; painful arc and positive Jobe test; baseline SPADI 62%; plan is three-phase loading with review at six weeks." For an insurer, the same content would foreground functional limitation, expected recovery time, and measurable goals.

Red flags must be screened and stated explicitly in any presentation. For this patient, screening excludes cervical radiculopathy (no dermatomal symptoms, normal Spurling test), inflammatory arthropathy (no morning stiffness over 30 minutes), malignancy (no unexplained weight loss, night pain unresponsive to position change), and infection (afebrile, no warmth or swelling). Contraindications to loading, such as an acute full-thickness tear with significant weakness, should be documented before any progression.

Assessment: Tests, Measures, and Normative Values

A defensible assessment combines special tests, range of motion, strength grading, and validated patient-reported outcome measures.

Special tests should be reported with their results and their limitations. Neer and Hawkins-Kennedy tests are sensitive but not specific for subacromial pathology. The Jobe (empty can) test, described by Jobe and Moynes (1982), assesses supraspinatus involvement; a positive test with pain and weakness at 90° abduction and internal rotation is typical. The external rotation lag sign is a stronger indicator of a full-thickness tear, and a lag of more than 10° at 0° abduction is considered clinically significant. Combining tests into clusters improves diagnostic confidence.

Range of motion should be measured with a goniometer and recorded for both sides. Reference values for adults are approximately 180° flexion, 180° abduction, 90° external rotation at 90° abduction, and 70° internal rotation at 90° abduction. A deficit of more than 10° relative to the contralateral side is commonly considered meaningful, though the threshold should be interpreted in context.

Strength should be graded using the Medical Research Council scale (0–5) or handheld dynamometry (HHD) in newtons. Document the position, the method, and whether the result was pain-limited. Reporting "4/5 with pain" is more informative than "weak."

Patient-reported measures provide the functional picture. The Shoulder Pain and Disability Index (SPADI), developed by Roach et al. (1991), has a pain subscale (5 items) and a disability subscale (8 items), scored 0–100 with higher scores indicating greater impairment. The Constant-Murley score (Constant and Murley, 1987) combines pain, activities of daily living, range, and strength into a 100-point total, with normal values for adults in the 80s to 90s depending on age and sex. The Quick DASH is useful for work-related upper-limb presentations. Pain is recorded on a numerical rating scale (0–10), and baseline values should be reported with the reference period (for example, "average pain over the past week").

Management: Staged Protocol and Dosage

Management should be described in phases with explicit criteria for progression. Kuhn et al. (2013) reported outcomes from a multicenter cohort of physiotherapy for atraumatic rotator cuff tears, supporting structured loading programs as a first-line option for many patients. A typical staged approach for this patient is as follows.

Phase 1: Pain modulation and load management (weeks 0–2). Activity modification avoids sustained overhead work. Isometric rotator cuff exercises at 30–50% of maximal voluntary contraction, with five repetitions held for 45 seconds, are performed three times per day. Scapular setting and pain-free range exercises are added. Progression criterion: pain at or below 3/10 during and after exercise, with no night pain disrupting sleep.

Phase 2: Strength and control (weeks 2–6). Isotonic exercises are introduced: external rotation with elastic band, scapular retraction, serratus anterior activation, and prone row. A typical dose is three sets of 10–15 repetitions, three to four days per week, performed to 2–3 repetitions in reserve. Progression criterion: SPADI reduction of at least 13 points (the minimal clinically important difference reported in several shoulder cohorts) and pain-free active elevation to 150°.

Phase 3: Loaded function and return to work (weeks 6–12). Load increases toward occupational demands, including overhead lifting with graded weights, plyometric-style tasks if appropriate, and sport- or trade-specific drills. Dosage moves toward three sets of 6–8 repetitions at higher load, with a focus on endurance at work-relevant positions. Discharge criteria include Constant-Murley score above 80, SPADI below 20%, and symptom-free completion of a full working shift.

Each phase should be reported with the actual dose delivered, not only the intended dose. Adherence and any deviation from the plan are clinically important, and omitting them weakens an otherwise sound presentation.

Presentation Formats

Three formats dominate clinical teaching and communication. A verbal case presentation, typically 5–10 minutes, uses a structure of summary, key findings, working hypothesis, plan, and questions for discussion. A written case report follows an extended SOAP or problem-based format and should include the rationale for measures chosen. A poster or conference format condenses the case into a visual summary with a clear clinical question, key outcome data, and one or two take-home messages.

A verbal case presentation typically runs 5–10 minutes: summary, key findings, working hypothesis, plan, and questions for discussion.

A verbal case presentation typically runs 5–10 minutes: summary, key findings, working hypothesis, plan, and questions for discussion.

Regardless of format, lead with the clinical question. Listeners should know within the first minute what problem you are solving. Avoid reciting every finding in the order it was collected; instead, select findings that discriminate between hypotheses.

Clinical Pearls

  • Present the reasoning, not the transcript. A listener cannot evaluate forty measurements, but can evaluate three hypotheses and the evidence for and against each.
  • State the outcome measure baseline and the change. "SPADI improved from 62% to 34% over six weeks" is far more useful than "pain improved."
  • Name your uncertainty. Special tests have imperfect accuracy; saying "the Jobe test was positive, but the lag sign was negative, so a full-thickness tear is less likely" demonstrates good judgment.
  • Match detail to audience. Use technical language with peers and plain language with patients and funders, without changing the facts.
  • Document contraindications and red flags explicitly, even when they are absent. Their absence is part of the diagnostic argument.
  • Record the dose delivered. Adherence data distinguish a failed treatment from a treatment that was never fully applied.

Summary

Case presentation translates clinical reasoning into a form others can evaluate. Its purpose is to communicate a working diagnosis, the evidence behind it, and the plan and its outcomes. The audience determines the emphasis: peers need hypotheses and plans, students need reasoning chains, and funders need function and measurable change. Strong presentations integrate pathophysiology with the presenting features, report assessment findings with normative values and validated measures, describe staged management with explicit dosage and progression criteria, and acknowledge uncertainty. Format is secondary to structure, and a clear clinical question at the start is the single most effective feature of any presentation.

References

  1. Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;(173):70–77.
  2. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8(3):151–158.
  3. Jobe FW, Moynes DR. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med. 1982;10(6):336–339.
  4. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160–164.
  5. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991;4(4):143–149.
  6. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371–1379.

The other 11 chapters, all 144 MCQs and the flashcards are in the PhysioAI app.

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Practice questions

5 sample MCQs from this course. Tap a question to see the answer.

  1. A 58-year-old man is 6 weeks post left total knee replacement for osteoarthritis. He walks 20 m with a rollator, and he needs help getting in and out of the bath. His ward physiotherapist is handing his care over to the outpatient team.

    1. What is the primary purpose of the case presentation in this handover?

    • A. To communicate the patient's current status, goals and plan so the receiving clinician can continue care safely
    • B. To assess the student's knowledge of knee anatomy in front of peers
    • C. To replace the written clinical record for billing purposes
    • D. To give the patient a diagnosis they can share with family
    Show answer

    Answer: A. Clinical case presentations in handover settings exist to transfer essential information about current status, goals and the plan of care. Assessing anatomy knowledge, billing and patient diagnosis disclosure are not the core purpose of a handover presentation.

  2. A 58-year-old man is seen 3 weeks after a right total knee arthroplasty. He rates his pain at 6/10 when walking and can only walk 20 metres with a walker. He lives alone in a two-storey house and cannot yet manage the stairs.

    2. Which element should be placed first in a one-minute summary of this case?

    • A. 58-year-old man, 3 weeks post right TKA, walking 20 m with a walker
    • B. Complete list of his current medications
    • C. Detailed description of the surgical approach used
    • D. Every range-of-motion value recorded in the session
    Show answer

    Answer: A. The one-minute summary should open with the essential identifiers: age, sex, diagnosis, and the key functional limitation. This gives the listener an immediate frame for the rest of the presentation. Medication lists and surgical details belong later, if at all.

  3. A 67-year-old woman with breast cancer treated eight years ago presents with progressive mid-thoracic pain that is worse at night and does not ease with rest. She reports an unintentional weight loss of 6 kg over the past two months. She can walk only about 50 metres before stopping.

    3. Which red flag category is most strongly suggested by this presentation?

    • A. Possible malignancy, based on cancer history, night pain and weight loss
    • B. Mechanical low back pain with no neurological signs
    • C. Yellow flags indicating fear-avoidance beliefs
    • D. Hamstring tightness limiting hip flexion
    Show answer

    Answer: A. A history of cancer, night pain that is unrelieved by rest, and unexplained weight loss are classic red flags for malignancy. These features require medical screening and onward referral rather than simple mechanical management.

  4. A 58-year-old woman presents with eight weeks of right lateral elbow pain after repetitive gardening. She reports pain when lifting a kettle and difficulty gripping a coffee mug. The physiotherapist records examination findings during the session.

    4. Which finding belongs in the objective section of the case presentation?

    • A. Pain on palpation at the right lateral epicondyle with grip strength 60% of the left side
    • B. She feels her elbow is weak and is worried about returning to work
    • C. Her pain is worse in the mornings and she sleeps poorly
    • D. She believes gardening caused her problem
    Show answer

    Answer: A. The objective section reports observable and measurable findings such as palpation responses and dynamometer results. Patient beliefs, worries, and symptom patterns belong in the subjective section.

  5. A 68-year-old woman is 3 days post total knee arthroplasty. She has a 15-degree extensor lag, can walk 10 metres with a walker, and reports difficulty climbing the two steps into her home.

    5. Which intervention statement best presents the rationale for the planned treatment?

    • A. Quadriceps strengthening is prioritised because the documented extensor lag limits her household ambulation and stair access.
    • B. Daily passive hamstring stretching is prescribed to improve general flexibility before any strengthening.
    • C. Therapeutic ultrasound is applied before every session to reduce pain before exercise is considered.
    • D. Bed rest is recommended until her knee pain fully resolves, then mobility work will begin.
    Show answer

    Answer: A. A sound rationale links each intervention directly to a documented impairment and the functional limitation it causes. Here, the extensor lag and quadriceps weakness explain the walking and stair difficulties, so quadriceps strengthening is justified by the findings.

Flashcards

  • What is the primary purpose of a clinical case presentation in physiotherapy?

    To communicate a patient's history, examination findings, clinical reasoning, and management plan clearly to others so that care can be understood, evaluated, and continued. It also makes the presenter's reasoning visible, which supports safe and consistent decisions.

  • What are the four components of the SOAP framework, and what does each one capture in a physiotherapy case presentation?

    SOAP stands for Subjective, Objective, Assessment, and Plan. Subjective covers the patient's own account of symptoms, history, and goals. Objective covers measurable findings from tests and observation, and Assessment interprets those findings into a clinical impression, while Plan sets out the intervention and goals.

  • What is the main purpose of the subjective examination in a physiotherapy case presentation?

    The subjective examination gathers the patient's own account of their condition, including the history of the problem, symptoms, and how they affect daily life. It guides clinical reasoning, helps identify the working hypothesis, and determines which objective tests are appropriate. It also builds rapport and establishes the patient's goals.

  • What is the key difference between active range of motion (AROM) and passive range of motion (PROM), and why does comparing them matter when presenting objective findings?

    AROM is performed by the patient using their own muscle activity, while PROM is performed by the clinician with the patient relaxed. If both are equally restricted, the limitation is more likely from non-contractile tissue such as the joint capsule, ligaments, or bone. If only AROM is limited, contractile tissue such as muscle or tendon is more likely involved.

  • When presenting an intervention in a case, what three elements should the rationale explicitly link?

    The rationale should link each intervention to a specific impairment or problem identified in the assessment, the expected physiological or functional mechanism of change, and the patient's goal. Making these links explicit shows clinical reasoning and makes the plan easy for a supervisor or colleague to evaluate.

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