I have just completed my rural placement where i saw many different conditions across musculoskeletal outpatinets, paediatrics and woman's health.
One particular patient I had in outpatients had a total shoulder replacement a year before after suffering major tauma to his shoulder. The operation notes were just incredible and the x rays, both pre and post operation, were the most interesting I have ever seen.
Mr X had been back working for the past few months but was still lacking ROM from his shoulder especially abduction and flexion. Closer inspection revealed that his scapulohumeral mechanics had been altered and this was impeding him getting past 60 degrees in both directions.
I thought my inital 2 treatments should be starting to address this problem but further reassessment 2 weeks later revealed that only minimal improvements had been achieved. It was at that stage when i decided to get the senior involved as I was starting to run out of options for treatment. The senior and I both worked together on Mr X's shoulder for the next 3 sessions with minimal changes. It was then decided between the both of us that we needed further help and started contacting physios in perth, who had experience working with shoulder replacements and altered shoulder biomechanics.
If a situation like this was to present itself again, then as soon as i realise that i'm out of my depth, in terms of knowledge and treatment options, I should ask for help or advice as soon as i can. It will always be in the patient's best interests if I do so and i'll will always then learn from the experience. Has anyone ever come across a very hard patient to treat in an outpatients setting and were way out of the depth?
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Hey hendo, I also had a shoulder replacement patient who I had difficulty making gains with. This patient was only 1/12 post op and I wasnt sure how aggressive to be with Rx as post op orders said 'full AROM and PROM' however ortho texts said to be very conservative with Rx. After consultation with my superviser, she informed me that many shoulder replacements dont ever get full range and to do as much as I could. Although range of motion at the GHJ joint was very limited, I could already see how scapulohumeral rhythm was being affected and that this would be a large part of treatment further on. I really liked your strategy and initiative in asking for help when out of your depth.
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