Hey blogging buddies
Ive got a pretty interesting case that i wanted to discuss
I saw the patient on a Tuesday and the incident had happened on a Saturday afternoon whilst playing Rugby. In the last 5mins of the game the patient became concussed as he was accidently kneed in the head at the bottom of a ruck and immediately came off with a blood nose and did not return for the remainder of the game. He was advised to not fall asleep until at least 10pm at not to drink alcohol for at least 3 dayswhich are pretty standard instructions following a concussion. He did not have any injuries apparent following the incident. The patient followed instructions but awoke the next morning in agony unable to elevate his right arm at all. He was referred to a doctor on campus as he was friends with te rugby club who ordered an X-ray with no significant findings and then directly to the outpatient department.
Upon examination there was no obvious deformity around the GHJ and ACJ. His AROM was reduced globally with elevation movements being the most provocative and limited and pain over the deltoid insertion whilst PROM was quite well preserved with all movements nearing EROM. Empty can and full can in 30 degrees of scaption were painful but IR and ER in neutral, Speeds and lift off werent. The stability tests around the shoulder were all clear indicating that most likely there wasnt a dislocation and palpation along the anterior shoulder wasnt provocative. Palpation over supraspinatus in the supraspinous fossa was painful.
After discussing with my supervisor we most likely thought it was a supraspinatus tear.
Treatment consisted of mainly a HEP aimed at maintaining mobility and preventing secondary complications along with reducing pain. Pendular exs, Cx ROM, shoulder rolls, Thx rotn and elbow/wrist and finger exs were advised along with ice, a sling aimed at unloadng the GHJ and some education as to what we thought had happened.
Everything went well and we were keen to send him off for some investigations to confirm the structure involved went he informed us he was already going for an US on that Friday.
I thought great and booked him in for the following Monday hopefully knowing the exact structures involved and then the best course of Rx.
The following Monday came and the patient had not turned up to his appointment. I tried to contact him to find out why he didnt attend and what the results where but there was no answer. I tried to contact the Doctor involved but he was not answering his pager as well. There was no investigations put up onto PACS so i cant have a look at his US so most likely it was done privately. Ive tried to contact him over the past 2 weeks to no success.
Consequently, i have no idea what has occured to this patient. Did he have surgery? Is he being managed conservatively somewhere else?
Really i am just wondering what people think about what should be done now? I have been trying to contact him to no avail so should i just give up? Or should i try and get to the bottom of whats going on?
Maybe i should have things more clear upon the conclusion of our 1st session and discussed the potential outcomes and options folowing the US.
Subscribe to:
Post Comments (Atom)
2 comments:
There are several options here I think.
First of all, what do you think you should do?
I actually think you've been pursuing the most correct option here. I would continue to follow up with this patient, both by trying to contact him directly, and also by following up through the referring doctor. I'd also make sure you document each time you attempt to make contact, by what means (phone, pager, email, etc.) and the result (message left, etc.).
Aside from being concerned about his condition - both the shoulder and the concussion, it's good professional conduct.
Trudi
I agree with both Kappa and Trudi that as health professionals we need to be concerned about our patients condition and recovery and follow this up in a professional way but at the same time I think it is also important that the patient is active in their own treatment. If you have left him messages and have tried several ways of contacting him surely there is a certain point where you have to stop and leave it up to the patient themselves, especially one as able bodied as this example, to actively seek out help for themselves?
Post a Comment