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Hi Residents,
I was in last year’s class. This article just came out in one of the top medical journals in the world. Hopefully this will start to change surgeon’s practice patterns or possibly decrease reimbursement for this type of procedure. Questions for you:1. What do you tell the patient who comes in and says “Dr. SportsMed says I have a bone spur on my acromion and that is causing my pain. I don’t think it’ll get better until this gets removed.”
2. In a similar vein, what do you tell the patient who says “Dr. SportsMed says I have a hooked acromion and this is causing my tendon pain.”
3. How do you teach tendon pathology to your patients in order to create buy in? I like to put their arm in a position where I know the acromion is unlikely to be causing pain (Below 90 degrees elevation) and add load, and then when it starts to hurt I can show them it is the tendon causing the pain, and likely not the acromion. What other tricks do you use for buy in?Have a great thanksgiving!
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Hey Scott, Great post!
A patient of mine was listening to NPR the other day and heard about this article. Right after I pulled it up and read it. I think it is a great follow up to the meniscus one done a few years ago. These should be done for every part of the body for elective surgeries.
I agree with you that it is very hard to change someones belief system. I think that the fist thing we need to do as therapists is read the patient. Some people are not willing or wanting to be told something else. You could show them every analogy, video, and explaination but they will just not believe it. Sometimes they just have a higher trust in a medical doctor over a doctor of physical therapy.
I think that having an article like this showing how the surgery did not help as much as just cutting into them makes a stronger point for those skeptical patients who need the “higher ranking” profession to tell them.
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Hi Scott,
Thanks so much for posting! This is a great article and I definitely plan on using it for an educational tool for patients. I also like your strategy for patient buy in by loading the tendon in a position of decreased subacromial narrowing. My caseload is very light on shoulders right now, but I utilize a similar strategy with my patients with meniscal pathology. I use the article Kyle referred to to educate them on surgical outcomes vs. therapy to try to get them to commit to a month of PT to see if we can make any kind of changes without surgery, and re-evalaute at that time. I tell them if they aren’t seeing any changes in their symptoms by then, maybe we can consider contacting their MD regarding their symptoms. In these patients, I usually try to “feel out” their opinions on surgery, if they seem hesitant, I usually try to use this hesitation to try to convince them to give therapy a try before surgery.
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Hey Scott,
I dont know if you’ve seen this one yet or not. This is the article I am doing my December article review on. Its in the most current BJSM issue and explores biceps tenodesis vs. labral repair vs. sham surgery in patients with type II SLAP tears. They found significant improvements in all outcomes assessed in all three groups with no difference between groups.
Like the article you posted, I think this one provides an excellent educational opportunity for us with patients presenting with these impairments and pathologies that are considering surgical intervention for their pain.
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