Today, I saw a patient who sustained a fracture and I was shocked by how she had been coping with the fracture.
Mrs X is a 50y.o female, sustained a fracture of the L humerus 8/52 ago. Since the injury, she had been on a cast for 6 weeks and then a sling for the last 2 weeks. Mrs X was referred to physiotherapy for passive and active assisted ROM exercises. As usual, after subjective assessment, I went on to do objective assessment. The position that I chose to measure PROM was supine. However, Mrs X commented that she cannot lie supine. She commented that the doctor’s instruction to her was that she cannot lie supine due to the fracture. This kept me thinking how she coped with her sleep. Amazing, Mrs X had not been sleeping supine for 8 weeks!! She had been sleeping in a long sitting position. Mrs X was also told not to do any exercises without the brace (she had not move the shoulder for 8 weeks!!)
Due to the doctor’s order, I did my assessment in sitting and also with the brace on. The shoulder PROM was largely limited by pain and elbow movements limited by the brace and there was massive swelling of the UL (which I thought would have resolved after 8 weeks). My treatments for Mrs X were to teach her pendulum and active assisted exercises and swelling management. To further facilitate the rehabilitation process, the plan was to contact the doctor in charge to check if the patient could lie supine and do exercises without the brace. Lying supine would make some ROM exercises for the patient and treatment without the brace would promote more range at the UL joints. It is amazing how some patients cope with their fracture and I think education about the dos and don’ts is very important and fracture is definitely the worst thing to get.
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Ah yes, education!! So important hey! I would say that probably half of my fracture patients had had good education re: do's/don't etc about their fracture and protocols. A few however were shocking! You have to wonder sometimes though is it the medical staff or the patient? Some individuals don't understand things on the first run through - and for some, just dealing with the acceptance/shock of the injury/fracture is all that they can take in!! It is these patients who nod their heads as you speak, but that glimmer of understanding just is not flickering in their eyes - that you need to really ensure that you change tact and get across the important stuff. That said, some medical staff can be shocking in what they do or don't say as well. So ya, education definately goes with the job description for physio!
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