10/03/2018

Dear Dr. Bronwyn Clarke

Orthopaedic Surgeon

Main Hospital

Greenville

Dear Dr. Clarke

Re: Mrs. Maria Santini , aged 67

I am writing to refer Mrs. Santini, a widow who shows features consistent of worsening bilateral knee
osteoarthritis and right sided Baker’s cyst which has tilted her into depression. She requires your expert
clinical review and management.

Mrs. Santini has two children but lives alone in a two-storey house. She is a non-smoker and does not
drink also. She has been on treatment for her hypertension and dyslipidemia since 2003 and AF since
2009. She underwent successful bilateral hip replacement in 2013. Her osteoarthritis was started in
2006 and she takes glucosamine for this.

Today , Mrs. Santini arrived with complaints of progressively increasing bilateral knee joints pain of 6
weeks duration which resulted in significant impairment of her daily living activities. She also started to
notice a soft lump at back of her right knee 4 weeks ago. In addition, she was experiencing irritability,
agitation, reclusiveness along with social withdrawal. On her assessment, crepitations were noted into
the both joints during movements; nevertheless there were no other significant abnormality observed.
Her lab results were found to be normal; however, her MRI revealed degenerative changes consistent
of OA.

In light of the above, I would greatly appreciate your further management for Mrs.Santini‘s condition
including possible steroid injection . Please be advised, she requires a physiotherapist review as well.

Should you have further query, please do not hesitate to contact me.

Yours sincerely

Doctor.