The team approach

In the last couple of weeks I have been treating a pt who was 1/52 post suspected L CVA. He was presenting with R UL weakness and expressive aphasia. He was 85 years old and had a previous history of decreased dynamic balance in standing and c/o feeling shaky on his feet [able to walk <60m (I)]. The pt was improving rapidly from the very mild CVA (R UL went from Gowland 3 to 5, able to pour glass of water and brush hair, Aphasia improving) and was more concerned with his balance. Very well, there in lies the plan for treatment. Over the next week he improved until one day I came in and he c/o feeling unwell. His arm had decreased in function, speech the same. Over the next week he gradually deteriorated to Gowland 2 and was so shaky on his feet he couldn’t get to the bathroom (I).Recent scans showed full thickness SS tear and partial IS tear in the affected shoulder. However, pt reported shoulder pain for 3 years. The doctors were discussing with the pt the possibility of joint injection for the shoulder function. I told them that subjectively he had shoulder pain for 3 yrs and his Gowland had dropped from 5 to 2/3. Voluntary control loss indicated that the pt was having another infarct and was not related to long term shoulder dysfunction as 3 days before he was brushing his hair. The doctor agreed but did very little about it, this was very frustrating and beside my point. My point from all of this is don’t be shy, we know a lot of information from our course it’s important we communicate what we find to the doctor’s to make sure the pt gets the best treatment. It’s a team not a hierarchy.