Neck? Shoulder? Both?

[Farisshd]

Neck? Shoulder? Both?
I recently had a new patient evaluation for an early middle aged Amazon warehouse worker with separate shoulder complaints in both shoulders. She has never been to a physical therapist prior and was very stressed over her symptoms and her inability to work without pain over the past few years. Initially, I picked up on her anxiety and simply allowed her to tell me her situation, what has her stressed, and all about her symptoms. The patient body chart indicates symptoms in her R upper back in the middle trap and rhomboids with occasional pain in her R breast, pain in her L shoulder in the anterior and middle deltoid, and pain in her lower back. She worked mostly sorting small packages and spent several hours a day standing and reaching overhead to grab and toss small packages to the appropriate bins. She also spends considerable time bent over to sort through bins of packages and carrying large plastic bins full of small packages.
She put me to the test a bit between being quite anxious over workplace concerns as well as pain, and with her symptoms not being as straight forward as many of us would like on evaluation. I worked to keep a level head and calming demeanor as I completed the subjective portion and moved into my examination with limited time following the discussion. While her cervical ROM was grossly limited, I was unable to reproduce her symptoms directly with cervical ROM, overpressure, compression, or spurling’s, and noted equal and intact sensation bilaterally. I turned my attention to her shoulder complaint, though not completely convinced there is no cervical component. After some testing, it appeared that the left shoulder had an impingement contributing to her symptoms, and with hypo-mobility of her CTJ and upper thoracic spine I suspected referral from these areas contributing to her R sided complaints, and planned to further assess in future sessions.
Due to limited time, I focused my initial intervention on the L shoulder complaint, and scheduled the patient for her follow up sessions. I felt that it was very good for me and the patient to allow her to unload her concerns and take the time to educate her on the role of PT and the expectations throughout the plan of care. I felt that I was able to get her started with appropriate and effective home exercises to address some of her complaints. Due to her anxiety and heightened level of irritability, I was unable to complete all tests, and had to wait until the next visit to assess ULTT’s which I would have tried to assess in the initial session if I had the chance to perform this initial evaluation again. I think if I had a similar patient encounter again, I would handle the subjective exam quite similarly, though I would attempt to redirect the patient more efficiently in order to allow for more time to perform my objective examination.
The patient was very helpful by bringing her knowledge of her work responsibilities, history of symptoms, aggs and eases, and having already taken the initiative to bring in a form for me to make recommendations for limitations to her work activities during her recovery. I believe her initial encounter allowed her to buy in to the benefits of physical therapy and to build trust in me s her provider, giving her hope for a targeted treatment approach that is structured to allow for a timely and satisfactory recovery. I believe she perceived me as genuinely caring and concerned for her situation and recovery, and I felt that she was motivated and legitimately driven to feel better and return to her full work and ADL capabilities.
I have only seen this patient twice so far, but feel that this will be an excellent learning opportunity for me, and that the knowledge and skills I have picked up in the first two weekends in the course series will allow me to better impact this patient and her recovery.

• This topic was modified 9 months, 1 week ago by Farisshd.

[AJ Lievre]

Hunter,
Thanks so much for the post. It sounds like you did a lot of listening during the subjective interview. As you mentioned, she appeared anxious and concerned about her ability to complete her work duties. Did you acknowledge this and verbalize it to her in some way? Or was this more of an observation on your part? If you did acknowledge it, how did she respond?
Thanks
AJ

[Farisshd]

AJ,
Thank you for reading. Yes I did acknowledge her concerns over her job and having her bosses understand her limitations. We discussed how she loves working and needs to continue, as well as her concerns that they will put her in the area that she does not like working if he is simply given a lifting restriction. She was very clear that a significant portion of her anxieties stem from feeling that she keeps getting placed in the sorting area that is provocative because she is a fast worker, and that she would like to have time limitations and activity limitations. She felt that this would allow her employer to have a more structured approach to her assignments and seemed relieved to have the form completed indicating activities to limit and/or avoid during the period of care. The patient responded well, expressing gratitude for the care and consideration, and a better understanding for the role of physical therapy.

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