Urgent Help Required With Fractured Humerus

[bobbyjean]

Hello.

I am a student physiotherapist who is getting very stressed out about a patient I am due to see on Tuesday (2 Dec 08) !!

My patient is a retired lady (67 years old) and has been referred to physiotherapy by her GP. At the moment I know that roughly eleven weeks ago she fell off a stool onto her shoulder and fractured the surgical neck of her left shoulder. She has been treated with a collar and cuff which was followed by some mobilization. The GP’s referral stated that her shoulder is stiff over the deltoid area down as far as her elbow and her shoulder movements are restricted in a capsular pattern.There has been no other X-rays since the initial x-ray was taken when the incident occured.

I cannot come to a conclusion as to why her pain is radiating down as far as her elbow
and I would sincerely appreciate any help in this regard. I have many ideas in my head (far too many to mention here) but I feel like I’m going around in circles. I would greatly appreciate any help you could offer this stressed student!

Thanks again.

[jonathan.k]

Hi Bobbyjean,

As you have mentioned, there may be many reasons to why the patient is experiencing the pain and stiffness.

Does your hospital have a clinical reasoning and planning sheet you can utilise? They help you to think about what you are doing and in most cases make it easier for you to understand whats going on.

From the subjective and physical examinations, list a few significant findings. Then make a few provisional diagnosis. Test these PDx. Find strategies that you will use as management/treatment. Reassess to test efficacy.

Things that you may need to consider:
diagnosis
management of inflammation
neurological deficit
ROM
neural tissue mobility
muscle length
movement patterns
stability issues
muscle activation issues

The above steps are what i would take when faced with a patient like yours.

Also, have a read of the discussion section of the attached article regarding management post minimal displacement fracture of humerus.

Hope this helps.

Cheers