Week 2 Day 4-5

On Friday I had a patient that made me really nervous just from reading his notes. He had fallen off a table at his own 50th birthday party after a few drinks and dislocated his elbow. From looking at his x-ray it was a huge displacement and amazing that he had so little soft tissue damage.

He was delayed in getting into the physiotherapist in the first place due to the long waiting lists, and apparently there is only a small window of opportunity for regaining ROM with dislocation, which he consequently missed. When he presented to the physio department he had 2 treatment sessions which regained some of his ROM but not much. After the 2 treatment sessions he returned to his specialist for his routine check-up, and the specialist was so worried that physio was stretching his ligaments too much that he stopped him from seeing a physio until the specialist decided it was ok to go back.

Luckily, when he went back to the specialist he had to see another doctor instead who promply put him back into physio and couldn't believe he had been taken out in the first place. Once he began treatment again he was 20 degrees off full elbow extension. He had 6 treatments; 3 with a curtin 4th year and 3 with a curtin 3rd year. When I was speaking to my supervisor about seeing this patient I expressed my concern about more experienced students not being successful with the patient and that they had exhausted all of the treatment options I had in mind. We decided that I would give it a go after having done my own assessment and if there was no improvement by the time my placement was up he would have to be discharged.

Earlier I had had another discussion with my supervisor about the use of accessory mobilisations and that he believed that if a joint was stiff it wasn't so important what direction it was moved in, but just that it was moved. So I decided that I would have a try at a different direction than the other students had attempted, even if it was against convention. It so happened that I got 4 degrees improvement. It was one of the best feelings!