The task
Assume that today's date is 22 October 2026. You have just assessed Mr Tuilagi in the clinic.
You are a physiotherapist in a private physiotherapy practice. Using the information in the case notes, write a letter to Dr Hao Baek, the orthopaedic surgeon who performed Mr Tuilagi's operation. Update him on Mr Tuilagi's condition and request an urgent review at his next available clinic because of a suspected re-tear. Address the letter to Dr Hao Baek, Orthopaedic Surgeon, Suite 3, 45 Victoria Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Update letter.
Case notes
Patient details
- Name: Mr Tane Tuilagi
- DOB: 03/05/1979 (47 yrs)
- Address: 14 Kowhai Street
- Referred by Dr Hao Baek (orthopaedic surgeon) for post-op rehab after R rotator cuff repair
Social background
- Self-employed builder; R-hand dominant; off work since surgery
- Keen to return to work ASAP — financial pressure
- Lives with wife and 2 teenage children; wife drives him to appts
- Plays touch rugby (not since surgery); supports local league team
- Wife unhappy with clinic car parking and receptionist's manner
Medical history
- Arthroscopic R supraspinatus tendon repair 13/08/26 (Dr Baek)
- Hypertension — amlodipine daily
- Smoker 10/day; trying to cut down
- L ankle fracture 2015 — fully recovered
- Allergies: NKDA
Progress to date
- Sling 6/52 as per surgeon's protocol; weaned 24/09
- Wk 8 review (08/10): AROM flexion 140°, abduction 120°; pain 2/10; progressing as expected
- Active-assisted → active ROM programme; good adherence to home exercise programme
Current presentation (22/10/26)
- Slipped on wet bathroom floor 17/10 → fell onto outstretched R arm; seen in ED same day — R shoulder XR: no fracture or dislocation
- Immediate sharp pain R shoulder; 'felt something give'
- ↓ ability to lift arm since fall; pain 7/10 on movement; night pain ↑, waking 3–4×/night
- Taking regular paracetamol — partial relief
Assessment
- AROM flexion 60°, abduction 45° — unable to hold arm in elevation
- PROM flexion 150° (similar to previous); pain at end of range
- Drop arm test +ve; ER lag sign +ve; weakness on resisted abduction and ER
- Wounds healed; no redness or swelling; afebrile
- No deformity; sensation and distal neurovascular status intact
- Pt asked whether he could use a nail gun overhead next month
Treatment and plan
- Bony injury excluded on ED XR, but ?re-tear → active ROM and strengthening ceased; gentle passive/pendular exercises only if permitted by treating team after assessment of injured repair — then pain-free range only; stop if symptoms ↑
- Advised to avoid lifting, overhead reaching and weight-bearing through R arm
- Advised to see GP re analgesia; ice for comfort
- Next scheduled review with Dr Baek 12/11/26 — ?re-tear: phone Dr Baek's rooms today to request urgent review at next available clinic; if team cannot be reached → arrange urgent assessment via ED; tendon imaging (US/MRI) at surgeon's discretion
- Continue physio weekly pending surgeon's advice
- Pt anxious about possible further surgery
Who is reading, and what do they need?
Dr Baek performed the repair and knows the operation and protocol. He needs to be told quickly what changed after the fall, which findings suggest a re-tear, what has been stopped, and what is being asked of him. He does not need background on the repair itself or non-clinical complaints.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Arthroscopic R supraspinatus repair 13/08/26 (Dr Baek) | Anchors the letter to his own operation and the post-operative timeline, in a single brief reference. |
| Sling 6/52, weaned 24/09; wk 8 review: flexion 140°, abduction 120°, pain 2/10 | Gives the pre-fall baseline against which the current loss of active movement is judged. |
| Slipped 17/10, fell on outstretched R arm; 'felt something give' | Mechanism and immediate symptom are the basis for suspecting a re-tear. |
| ED same day: R shoulder XR no fracture or dislocation | Tells the surgeon what imaging has been done and that it addressed bone only. |
| Pain 7/10 on movement, night waking 3–4×/night, regular paracetamol partial relief | Shows symptom severity and the limits of current analgesia, supporting urgency. |
| AROM flexion 60°, abduction 45°; PROM flexion 150°; drop arm and ER lag positive | Key objective findings that support suspected tendon failure: active range lost while passive range is maintained. |
| Wounds healed, no redness or swelling, afebrile, neurovascular status intact | Relevant negatives that show no signs of infection or neurovascular problem were found. |
| Active ROM and strengthening ceased; avoid lifting; review requested before 12/11/26 | States what the physio has done and the specific request, including the gap before the scheduled appointment. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Wife unhappy with clinic car parking and receptionist's manner | A complaint unrelated to the shoulder, not suitable for a clinical letter. |
| Plays touch rugby; supports local league team | Recreational detail irrelevant to the suspected re-tear. |
| L ankle fracture 2015 — fully recovered | Resolved, unrelated injury. |
| Asked whether he could use a nail gun overhead next month | Looks relevant to work, but return-to-work questions are premature until the suspected re-tear is assessed. |
| Hypertension on amlodipine; smoker 10/day | Background history that can be left out or compressed, as the letter's purpose is the new shoulder problem. |
A paragraph plan for this case
Open with the purpose, the request for urgent review and the original operation. Then describe progress before the fall, the fall and current findings in separate short paragraphs. Close with what you have changed in treatment and the specific help requested.
Where candidates slip on this task
- Write that a re-tear is suspected, not confirmed. The X-ray showed no fracture or dislocation but does not assess the tendon, and no tendon imaging has been done.
- Keep active and passive range separate: the wk 8 figures and current 60° and 45° are active, while passive flexion of 150° is the comparison showing movement is still available.
- Word the request politely but clearly: urgent review at the next available clinic, ahead of the scheduled 12/11/26 appointment, and ask for guidance on any passive exercise while physiotherapy continues.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Physiotherapy letter tasks
- Frozen shoulder - progress has plateaued update letter
- ACL reconstruction rehab - patient relocating referral letter
- Discharge to pulmonary rehabilitation after COPD exacerbation referral letter
Your profession's guide: OET Physiotherapy. Layout and structure: OET letter format.
Questions about this task
Should I say the rooms were phoned?
The notes give the plan to phone today, not that it happened. Do not claim a call was made or answered. The letter can simply make the request in writing and refer to the scheduled review.
Do I include his anxiety about further surgery?
A brief mention is reasonable because it is patient-reported and relevant to the surgeon's discussion. Keep it short, and do not imply surgery is needed or likely.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
OETAce is an independent practice site. OET is a registered trademark of Cambridge Boxhill Language Assessment (CBLA); we are not affiliated with or endorsed by CBLA. All practice material here is original.