Eventful Post-Op Shoulder

[Sarah Frunzi]

I have recently been working with a patient that is 4 weeks post-op biceps tenodesis and subacromial decompression and have been working with her since her first follow up visit after initial evaluation. Though fairly straight forward with recovery and treatment in regard to following protocols, post-op patients have been an area that are out of my comfort zone. However, in this case, she is a prior patient I worked with prior to her surgery, so there is a sense of familiarity and comfort for both of us as she was also hesitant to have a new therapist during recovery. The first follow-up visits went well, but the first few days were fairly rough for her in general after having an unpleasant surgical experience; emotions and anxiety were a large factor in the initial days post-op and definitely play a role in shaping her view of initial recovery. She also had an adverse reaction about one week after surgery to a medication that landed her in the ER which added an extra layer of stress and anxiety. Initially, I was unaware of why she was in the ER when she had cancelled her appointment, which had me concerned, though I found some relief in knowing she was planning on coming to her appointment the following day. Thankfully, her ER trip was not related to her surgery, and we were able to proceed with treatment as planned and all medical issues/concerns were addressed by that time. Needless to say, the first two weeks were overwhelming for my patient, and I felt my job was to not only follow protocol regarding her shoulder, but to help alleviate some of her stress and concerns with the experiences she has had so far – to be encouraging and to redirect her thoughts to the positives moving forward. This was an opportunity for me to build rapport and trust with her.
This patient has had prior shoulder surgery on her other shoulder several years ago, so she brings the knowledge of what that previous recovery experience was like for her. She endorses that this recovery is much easier and more tolerable than her prior surgery, despite the unpleasant events that have occurred. Though she had a rough start, the past 2 weeks have been smooth and uneventful with good progress noted in her PROM and pain levels. I believe this patient perceives me as someone who cares about her more than just her shoulder injury and that I am willing to listen to the other aspects of recovery that bother her and cause anxiety. I perceive her as a patient that is somewhat guarded from prior experiences but has let that guard down with me more each visit as we build a therapeutic alliance. I continue to use these events and moments as learning experiences to better improve my patient care skills and abilities. Should I have a patient encounter similar to this in the future, my goal will remain educating the patient on what normal sensations and feelings are that can be present during the recovery process, and to provide reassurance on concerns and fears immediately post-op.

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