Whilst on my rural prac I was seeing a patient who had undergone a shoulder arthroplasty operation due to arthritic changes to the joint. This arthroplasty however failed and the surgeons performed a reversal so the ball and socket were reversed, this provided a problem from the outset in terms of rehabilitation potential.
Not only did techniques have to be altered for example a caudad glide was now performed over the clavicle but the issue of how much movement the patient was going to get back was also raised. The patient although 6-12 months post surgery had limited range, pain at end of available range was also a factor. The patient would continually ask how much range they would get back and whether the pain would go away. I found it quite difficult to answer these questions for the patient.
After each treatment there would be some improvements in range 10 degrees at most, however even though the patient was diligent with there exercises this would fluctuate, I tried to stay positive to encourage the patient but I could see the patient was starting to perhaps realise that there wasn't going to be much more improvement. It was at this stage that after discussing the situation with my supervisor that I talked to the patient and explained that this may be the case.
Following this in the next few session it was clear that this had helped the patient, they continued to work hard at maintaining the available range and strengthening in this available range in an effort to maximize function of the arm.
I think if i have to deal with a situation like this again I will try to be as honest as possible as although our aim of course is to get max range and minimal pain there may be cases due to unforeseen circumstances where this may not be the case, and for the patient to be aware of this I think a better outcome can be reached.
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That is an interesting surgery. I have never seen a "reversal" such as that! I can see how it would be difficult to "predict" how much range the patient would achieve - always difficult if you can't reflect back on what may have occurred in similar situations. Although, realistically, as you mentioned, it would be very very unlikely she would ever achieve full range. This situation again highlights the need to set functional goals - although the patient may not make significant gains in range, through maintaining what she has got, strengthening and learning to adapt, she might very well progress functionally. The second thing this situation highlights, is to set short term functional goals early so those functional gains can be highlighted even in the absence of significant changes in things such as ROM.
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