Our Healthcare System

I wanted to share this experience from a few days ago...

I had an initial evaluation of a 76 y/o female

The prescription had a diagnosis of bilateral radiculopathy of the shoulders and a box checked off for "evaluate and treat"

She had a fairly extensive past medical history that I will leave out as well as a few clinical findings secondary to lack of relevance.

As I went through the patient interview, radiculopathy was less and less a likely culprit in her shoulder pain. Although she had a positive neer, hawkins-kennedy, and yocum special test, they simply created pain in the same location where just about any movement caused her pain. Moreover there was no radiation of pain which can be common in "radiculopathy". Distraction and Spurlings tests were negative. Also, the Yergason and Speed test were positive and the bigger piece to the puzzle was the fact that the only area of tenderness was on both biceps tendons.

She went on to describe that when she had pain in her hips and knees about three months ago she would use her arms to help her get up out of chairs. Her shoulder pain developed in conjunction with this other pathology.

Her MRI report from two weeks ago showed that she had minor tears in the infraspinatus, suprapinatus, and subscapularis along with minor arthrosis. She said her doctor mentioned only a possibility of bursitis and she claimed he never looked at the MRI report. NSAID's and aleve provided little to no relief.

Ultimately all signs point to bicipital tendonitis. Now we must call up the MD to report our findings. Ideally, there was no need for the MD visit. The patient could have saved herself that trip and extra payment that accomplished nothing more than referring her to us. We were able to screen for any red flags and are certainly able to refer elsewhere if there is an issue present outside of our scope of practice. For musculoskeletal issues PT should be the first line of defense aka the practitioner of choice. Unfortunately, this patient is one of many such cases and the situation will be one big speed bump to overcome, but it certainly is worth the fight.