week 3 STARES

week 3 STARES

S- In week 2 I saw my first patient by myself. The patient had been diagnosed with a shoulder impingement and biceps tendinitis. She has also been to the physio here for a number of other problems however and has numerous pain issues. She attends a class run by the physio department during which she sits out most of the exercises due to pain. She came to our appointment wearing a sling and was displaying her illness very obviously.
T- I had to perform an assessment and treatment to best help this patient, keeping in mind her pain issues and trying not to feed into them any further.
A- I performed a thorough assessment. A few things that I noted were that her active shoulder range on assessment was no further than 120º yet she could take off her jumper using full shoulder ROM. She also had very poor posture and didn’t understand her diagnosis or what it meant in terms of her pain. As such, I really focussed on education. I made sure she understood the mechanism of her pain and how poor posture affects her shoulder and really is the solution to her pain. I also discouraged her wearing of the sling but suggested she ice her shoulder to help with inflammation. I then gave her an exercise program focussing on improving her posture and strengthening her rotator cuff.
R- The patient was really happy with the explanation of her pain and felt that knowing the problem gave her more control of the issues. She performed the exercises well and was happy to continue them at home. I also saw her at the exercise class a week later and she said her pain had reduced and that she was constantly correcting her posture.
E- I was happy with how our session went. I was especially happy with my explanation as I feel that her interpretation and lack of understanding was having the most impact on her pain and her ADL’s. (As wearing the sling meant she couldn’t do too much). I think though that I need to get into a much better routine during the assessment, as I had my patient moving from sitting, to supine to prone…etc and it was a bit all over the place. She also had some trouble moving on and off the plinth so it really didn’t help! Next time I see her (or any other patient) I am going to organise my tests into those categories before I start so I am more confident and prepared.
S- The strategies I used were education and postural re-education. I was happy with how I used these and my confidence in the education process.