This blog has nothing to do with bones, just to warn you! Well here we all are again and another week has flown by..!
This week I began my musculo placement, and found the transition a bit difficult. To be thinking cardio and then all of a sudden joints, necks, backs etc, without a bit of a break in which to prepare, revise etc is hard and frustrating! Hard to be trying to revise on the spot with a patient in front of you, and frustrating because I think one could get a lot more out of it, and learn a lot more from great experienced supervisors if time wasn’t being spent trying to remember the basics, which in reality in a day or two of ‘free time’ could easily be achieved.
With my complaint out of the way I’ll now reflect on one of my patients who presented a bit of a challenge to me…..the challenge being where do I start??!!
She is a 74 yr old lady who fell 2mnths ago and sustained a full thickness tear of her R RC tendons, and partial of her L RC. She wasn’t referred onto PT then (..gggrrrrrr!!!) and so 2 mnths later can’t move her R shlder more than 20deg flxn or abdn; her L arm is better but severely limited in ROM too….and both are extremely painful etc. Having done her assessment for about an hour I then did soft tissue massage, release etc, and then as part of her HEP gave her pendular exs for her R arm as she couldn’t even do A/Assist. In thinking about her I found it difficult to know how long it would take for a patient like this to improve, what sort of function can she realistically expect to get back etc. And good ol’ Max did come to mind thinking about all the chronic pain pathways that have been set off and how to try and tackle that area of treatment. So that’s it for now…I’ll fill you in as to how she goes!!!
3 comments:
Hi claire,
I can relate to your frustration when you realise that some Drs don't refer pts to physio when it could clearly have helped them much more if referred earlier.
I had an experience with this pt who had an ACL reconstruction, he wasn't told anything post op, as in what he could or could not during the recovery phase, even the duration of recovery, or what to expect or take note of. He was finally referred to physio as his ACL repair was a failure, no indication of fall or any sort of trauma. But i just thought that the Dr should have been more responsible, as it may have been a preventable situation.
As for this lady pt of yours, I cant tell you the prognosis for her. Was thinking, probably after trying out a few sessions of physio, trying to improve scapular stabilizers & manage her pain & ROM, if no improvement a surgical procedure may be neccessary. If there's some improvement, if would be worth keeping up with that.
Meanwhile, keep us updated!
Hi Claire,
I couldn't agree with you more regarding the transition from cardio to musculo! i also feel that even one day would have been good to wade through the many special tests and revise anatomy for each joint/muscle and bone. Some of these techniques i am trying to recall from first semester first year. Well i hope you have a better experience this week once you settle in a bit.
Hey Claire,
these kind of patients are tricky, as you will probably not see alot of improvement quickly. Have you thought of referring for hydrotherapy, as this has worked with patients of mine in a similar position in the past. best of luck.
Troy
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