Im on musculo placement at Curtin Clinic. I was treating a patient with LE on a patient who had severe constant elbow pain. i performed the 3 specific LE tests and they all came up negative as they did not reproduce the pain. My supervisor came in to see how everything was going and she started to palpate the patient's neck to see if that could be the source of the problems and referring pain to the elbow. the patient became upset as she said she came in with elbow pain and now she had a very sore neck. the supervisor explained how her neck could be the problem and told me to do an ax on the neck to see. She left the room and the patient strated to cry saying that she was now in even more pain and she didnt like my supervisor. the patient wanted to leave and not continue the rx session, i suggested that i do a STM on her elbow as that had previously been effective in decreasing her pain - she agreed and i started to massage her elbow. When i was finishing up the massage my supervisor came into the room and asked the results of the cervical ax, i explained that the patient was in a lot of pain and would prefer to come in next week for a more thorough ax. the patient then asked my supervisor what day she was working so she could come in on that day. My supervisor said that as she was there most days she would probably be there. Once again she tried to explain that the neck could be the source of her problems especially as it was so tender. the patient made another appt and left saying that if she now had neck problems then my supervisor would be hearing from her.
All in all it was a very frustrating rx session as the patient left in more pain and had decreased confidence in our ability to help her. It is going to be an extremely challenging next rx session as she does not want my supervisor involved and i have no previous experience in treating LE.
2 comments:
Sorry forgot to spellcheck and meant to say that she asked what day my supervisor was not working so that she could come in on that day.
That's a tough situation to deal with. It's difficult to try and balanace the needs of the patient with what you believe to be the underlying problem. And it complicates matters when the patient decides she doesn't like the supervisor!
I think given the circumstances there wasn't much else you could do. I liked the way you avoided aggravating the neck and started STM on the elbow. It was a good idea to start with something the patient was familiar with and believes to work.
I think it will take a while for her to come around to your way of
thinking but all you can do is try and explain why you want to assess the neck.
Are there any pain management strategies the patient has already put in place? Or any that you have given her? Once her pain is bettre managed it may be easier to conduct a more thorough assessment. Is she able to move her elbow and wrist at all or does she not have much movement? i.e. are gentle AROM exercises a possibility? I must admit I haven't had my musculo prac so my knowledge is a bit sketchy.
Goodluck for your next Rx session!!!
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