Week 4

TREATMENT

Situation:
Patient A was 3 months post R HOH fracture, healthy bone density, fracture stable on Xray. Pt concerned about limited ADL's (brushing hair, reaching for things in the kitchen) Pt reports "It feels like it's stiff"

Task:
AROM R sh flexion = 130' P1 4/10 R2. Active ROM is equal to passive ROM R2. R GHJ AP's have increased stiffness R>L.
The aim of my treatment is to increase ROM.

Actions:
As active = passive and the decreased ROM is primarily due to increased resistance i decided to do grade 4 AP mobilisations to the R GHJ at EOR (130' flexion) 60 seconds x 1. I then reassessed Pt A, R AROM shoulder flexion = 140'.

Results:
I decided that my treatment technique had been effective so i continued with another two sets of 60 seconds. Reassessement the 2nd time was = 155'

Evaluation:
I feel that this was the most effective treatment for Pt A as she had a resistant dominant problem. I treated her at EOR flexion and used a grade 4 technique as the patient was not in too much pain. To reinforce my treatment technique i then gave my patient a take home exercise. This was active assisted flexion using the wall as added force in that EOR position.

Strategies:
When i first statrted my mobilisation technique the PT had quite a bit of localised pain over the area where i was holding her shoulder. I needed to change my hand position a few times to find the most comfortable position for the patient and still be effective. To do this i lowered the bed and brought my hands more distally up her arm, so i could apply my force in the correct line whilst maintaining soft hands.