OA in unexpected pt

Currently on my neuro prac, many of the pt's i see have a comprehensive PMH prior to being diagnosed with a neuro condition or having a stroke of some kind. One pt that i was treating last week was diagnosed with GB about 6/52 ago and had minimal PMH, with nothing contraindicating chest Mx, passive movements or sitting balance and stregthening exercises.

In the regular UL passive movements and chest physio session in the morning, the pt was complaining of pain at EOR with nearly all movements which was common for him. We gave more attention to his hands this session as we were waiting for the speech therapist to arrive. The pt was communicating via facial expressions that his L thumb was particularly painful. I continued doing these movements trying to avoid EOR and a painful response.

Later that day, another student saw the pt and reported to me that he had OA of the L thumb and he was needing pain medication to ease his symptoms. The pt normally had nil c/o pain at rest so this was alarming. From his social history of working a desk job, with minimal sporting activities, i would not have thought this was a possibility and when pain was present i didnt think to ask if he had any past history. This was likely because all movements were painful and my attention during PROM was to either get the pt to join in, or get the pt to think about something else to distract him.

To play this scenario again, subjective questioning about this OA would be a priority and due to the difficulat communication, follow this up with the pt's wife that visits regularly. If this was achieved techniques such as distraction could have been implemented to ease symptoms and increase pt comfort. Also relating symptoms back to previous days or the other side would give an indication of a past or developing pathology. I think its important to not just get into the habit of treating a pt a certain way, but rather continuous questioning and being flexible with assessment and treatment to tailer your session to the ever changing pt.