Clinical Cases

Middle aged adult with torn rotator cuff

During my second rotation, I treated a middle-aged male with an unrepaired rotator cuff tear of his right shoulder. He worked at a warehouse and injured his shoulder while lifting a heavy tarp.. Before I saw him, he had been coming to therapy for almost 2 months. He had a lot of pain with shoulder abduction and he could not move his arm past 90 degrees in any direction. Despite this, he was still going to work, although he had a weight restriction of 50 pounds. Treatment focused on maintaining his shoulder and elbow strength and function while staying out of pain-free ranges. We worked on things such as shoulder internal and external rotation at multiple angles to improve his shoulder stability. We also worked on some functional activities such lifting a dumbbell from waist height to shoulder height to simulate work activities. He was already working on some scapular strengthening at home and said that he would double up a green or blue theraband and do exercises that we were doing in therapy. Sometimes, if he was extremely sore, we would put a hot pack on his shoulder while he did the exercises. This seemed to ease his pain.

This patient was compliant with therapy and willing to do what he was able. In the beginning, we had to remind him not to overwork his shoulder so that he wouldn't be so sore in therapy. On one of the last times that I treated him, he mentioned that he had started using a lower resistance theraband for his exercises since it was about to get busy at work and his arm was feeling more sore than usual. I think that his actions demonstrated an improved sense of self-awareness.

Middle aged adult with hip arthroplasty

During this rotation, I also treated a senior male with an anterior right hip replacement. When I first treated him, he was exactly one week out of surgery. Initially, he had extreme quadricep weakness, significant tightness in his IT band, and pain at lateral knee. He also walked with a bit of a limp. At first, the main goal was to maintain his hip range of motion and improve his quadricep strength. We initially had him do supine heel slides and quad sets. Soon after, we added standing exercises such as marches and hip abduction. We also worked on a step-through gait pattern, making sure to avoid active hip extension and cued him to shift his weight equally onto both legs. In the clinic, we also had him do supine straight leg raises with assistance to start strengthening his quadriceps. To address his muscle tightness, we taught him how to self-massage his IT band with a paint roller. About 5 weeks later, the doctor lifted his hip precautions, and we initiated antigravity strengthening activities such as sidelying hip abduction and active hip extension while standing. By the time I left, he was able to do supine straight leg raises independently and his pain decreased, which were huge improvements. Had I worked with him longer, we likely would have worked on more antigravity knee and hip strengthening and emphasized muscular endurance, especially of his quadriceps.

This patient was invested in his treatment and always asked questions such as when he was able to drive. I would have to remind him that it takes awhile for tissues to heal and he couldn't overdo it. He wanted to return to work as soon as possible, which I think was a driving force in his motivation.

Surgeries: Hip arthroplasty and knee chondroplasty

On my second clinical rotation, I got to observe both a knee chondroplasty and hip arthroplasty on middle-aged adults. I had been treating many patients with these surgeries, so it was interesting to see the procedures performed and what was done before people are sent to physical therapy. For me, this experience put into perspective how many different tissues are involved in surgery and the importance of sticking to precautions that the surgeon gives to PTs and PTAs to follow.