The other day I had a patient with a vague onset of worsening shoulder pain. She had no complaints of any injuries, but for some unknown reason her shoulder was gradually becoming so tense and uncomfortable that it was difficult for her to do the smallest tasks with her dominant right arm. The pain even began to interrupt her sleep, and it forced her to take notice and do something about it.
One of the most satisfying things about being a physician is the ability to help patients help themselves. With a careful history of her daily activities at work and at home, it soon became apparent that some of her activities were new and coincided with the onset of her vague discomfort months ago. She had an “aha” moment, and could not believe that such small tasks that seemed so effortless when she began the new activities were now unbearably difficult to complete at the same pace and frequency.
We discovered together that she had a repetitive motion injury, and that she would need to modify her daily activities to allow that shoulder to heal. I educated her on how the healing process simply took time as the slightly torn or inflamed muscles, tendons and ligaments in the area slowly mended the fibers by themselves. The amazing human body! If she just took care not to further injure her shoulder for the next 6 weeks or so, then she would regain her full function and the pain would resolve.
I reviewed some simple range of motion exercises for her to start right away that did not stress the shoulder and would keep it fluid. I prescribed anti-inflammatory medications for pain, and scaled back her offending activities at work and at home. We planned regular physical therapy sessions 3 times a week for an initial trial of 2 weeks. I explained to her that the physical therapist would aid the healing process by teaching her the postural mechanics of the shoulder and how she can modify her activity to avoid hurting the injured areas in the future when she returned to full activity levels. The 45 minute physical therapy sessions would also include many different modalities such as heat to warm up before beginning the therapy, electric stimulation and/or ultrasound to aid circulation, massage to address any scar tissue buildup, very careful and specific light strengthening exercises, and finally ice to decrease inflammation.
I also reviewed some radiographs of her shoulder, and explained that although these pictures showed that the bony aspects of her joint were fine, it did not rule out other more serious injuries to the tendons, ligaments, cartilage, and muscles. If the shoulder became more painful and not less painful with physical therapy, then we would need to perform an MRI of her shoulder to rule out soft tissue injuries that might not heal by themselves, and might require surgery. I assured her that her exam indicated that this was not likely, but that pain was her guide, and she should monitor herself carefully.
Repetitive Motion Injuries are so subtle, and yet so debilitating. They can affect any body part that is used repetitively for long periods of time. I often see repetitive injuries and they can occur in any joints such as the wrist/elbow in tennis, the hand/wrist in computer keyboard use, the shoulder/neck in computer mouse use, the hips/knees/ankles/feet in running or operating heavy vehicles, and the back in any labor intensive activities. Cross training and strengthening throughout our lives minimizes the risk of any repetitive injuries, and as always, the level of prevention is a direct result of your level of preparation. An ounce of prevention is worth a pound of cure.
This case illustrates very well that the most important part of any doctor visit is the history. It takes time to take a complete history, and listening carefully is my priority. Being a good listener builds a strong foundation for diagnosing and treating any injury or illness properly. Communication is especially key in discovering the cause of a Repetitive Motion Injury and then implementing a treatment plan suitable to the patient’s needs. I never forget that injuries that limit our physical world are also very mentally draining and depressing to anyone. I address the patient’s disappointments and sadness, and aim to elevate their outlook with enlightening education and guidance through the difficult rehabilitation period.
My patient ended our first visit with the most gratifying “doorknob” comment. As I was leaving the room, she asked me if she could address one more thing. I turned around, closed the door again, and replied of course! She then told me that she had had the most pleasant experience at Marque Urgent Care, and that she wanted me to know that every single person she encountered at our facility had been “genuine” and “kind” and she really felt welcome here even on her first visit. She reported that it was the only time in an urgent care walk-in setting where she had experienced complete and undivided attention at all points of her care. She thanked me and our entire staff for our excellent listening skills, and obvious compassion. I thanked her so much for the positive feedback. Once again, I was reminded that I was blessed to be a part of the staff at Marque Urgent Care and that our care was making a difference in our community.The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.