ortho

Performed my first pseudo ortho/sports injury case today - haha actually more like an impromptu therapeutic session. I doubt I'll end up in ortho, but it's interesting to diversify from the neuro I am so used to loving. It's fun because friends now go, "Can you help me with _____?" and I respond, "Not really, but I'll take a look at it." It's exciting to have the added responsibility of going through a differential diagnosis like Gregory House does. It's also nice to do the practical application of classroom to the real world.



My friend experienced an anterior shoulder subluxation in May, which means his arm bone popped out of the shoulder socket and then back in. P. went to see a doctor, who said he most likely had a shoulder dislocation, which helped in my diagnosis (history!). I assessed his range of motion (ROM) in shoulder flexion, shoulder abduction, and shoulder extension, noting that he liked to cheat with his shoulder extension and abduct his arm slightly (limited shoulder extension). I also tested his horizontal external rotation and external shoulder rotation in the scapular plane and found ROM to be extremely limited for both.

I got empty end feels for external rotation and shoulder extension. Anterior subluxes are one of the most common types of shoulder injuries and typically impinge on the two ligaments that cross the joint anteriorly. Ligaments heal slowly so stretching the capsule gently and letting it heal naturally were both on my mind. Additionally, P. had difficulties resisting movements when I was doing some improvised manual muscle tests, I'd grade him probably a 4. Based on what I found, I figured the best course of treatment would be to strengthen the muscles performing external rotation and extension about the shoulder - infraspinatus and teres minor (not supraspinatus since his abduction was absolutely normal).

I proposed simple Therex:

"1. Apply heat to warm the infraspinatus and teres minor (back of scapula).
2. Perform shoulder shrugs just to loosen the muscles.
3. Find a door frame. Keeping your arms at your sides, bend the elbow to 90 degrees - you should look like you're trying to shake someone's hand but your arm is bent. Using the door frame to stop your hand, turn your body so that your arm rotates out, like the resistance I was applying to you today. Don't stress it too hard.
4. Lie down on your back on a bed or couch with your elbow hanging off the edge of the bed/couch. You want to start in a position like you're sitting in an armchair but on your back. Let gravity drop your arm backward, think of the motion you need to pull back your arm to spike a volleyball and that's the direction you want your arm to fall in. When that's too easy, put an object in your hand and repeat the exercise, increasing the weight of the object to your preference.
5. Lie on your front with your whole arm hanging off the edge of the couch/bed. Hold a light object in your hand and keeping your arm absolutely straight, extend your arm backwards - the action you want to do is like if you were starting to scratch the center of your back without bending at the elbow - arm extension and adduction. You like to cheat and abduct your arm away from your body when you perform shoulder extension so try to really bring your arm into midline when you do it.

I think those will address your primary concerns, remember to not stress it too hard and give it time to heal. Anterior subluxes commonly lead to dislocations."

I think P. is going to see an actual physiotherapist, and I'll check up with him to see if our answers correlate. This is really exciting that I'm already starting to be able to apply what I'm learning, even if I'm grossly untrained and underqualified to be doing this. I'm actually having fun in my program for once.