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What to do?
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What to do? - February 5, 2007 6:49:00 PM
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ptdan23
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I have been thinking about this for quite a long time (3 months or so) and still cannot decide what to do. I have a patient that was referred to me for L shoulder pain (previous h/o RC repair). She was later referred for L hip pain. I am still currently treating her for both (but now concentrating on L hip dysfunction).
Anyway, when she presented for her initial examination I evaluated both the involved and uninvolved side. Upon exam of the R side I found a weakness in the biceps and a bulge mid-biceps. I then went on and found her to have a positive Popeye muscle sign.
Pt told me that she had no injury but prior to coming to see me she had seen a chiropractor for her back/neck. She told me that at one of her treatments she happened to say that she had some aching pain in her R shoulder. She said that he proceeded to lift her arm up as far as it would go and pushed it as hard as he could. She told me that she heard a loud pop and had a lot of pain which she relayed to the chiropractor who didn't think much about it. She said that she had a lot of swelling. She then went back to him (not sure after how many days - less than a week I believe) and she told him how much pain she was having and he proceeded to do the same thing again which she said made it worse. I believe she went back to him once or twice after that but he did not doing anything with her shoulder.
It appears that the manipulations that this chiropractor performed caused a rupture of the long head of the biceps tendon.
My dilemma is what to advise the patient to do or what should I do? Should I continue on my current path of doing nothing, should I inform the patient to file a complaint w/ the state, should I file a complaint on her behalf, or should I contact the chiropractor?
Would really appreciate some guidance on this issue.
Thanks, Dan C., PT MTC
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Re: What to do? - February 6, 2007 2:00:00 AM
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JSPT
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Report your findings to the patient and simply tell her that it warrants further investigation. A letter to the referral source would help. I wouldn't hesistate to provide the information about the chiro in the letter to the MD. You obviously wouldn't say that he/she caused your observations, but that would be important to know.
I had the exact same thing happen with a patient last week. Based on her description, she was prone when the chiro placed his hands under the inferior angle of her scapulae and pulled cephalad. Immediately afterwards she had pain, and the next day a bulge popped up around the T4-5 area, near the lower trap.
I reported what I saw and didn't bother to draw the conlcusion. Both she and the physician figured it out on their own.
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JS
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Re: What to do? - February 6, 2007 2:18:00 AM
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jbird007
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I could share oodles of true stories regarding pts. injured by PT's but I won't. Although my comments are not to dismiss or defend, an injury is one the risks. Whether it was negligent and knowingly is a different category.
I think it is best to speak with the practitioner who was responsible. I must admit many times I got two completely different stories from the PT and pt.
JBird
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Re: What to do? - February 6, 2007 3:00:00 AM
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jlharris
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I don't think the point of the post was chiro bashing, jbird. I appreciate your zeal for your profession (wish most PT's were more like you), but your post has nothing to do with this situation.
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Jason L. Harris, PT, DPT
My PT Blog
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Re: What to do? - February 6, 2007 3:38:00 AM
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dfjpt
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Whatever happened to "Above all do no harm"?
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Re: What to do? - February 6, 2007 3:40:00 AM
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Jeep
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[QUOTE] Anyway, when she presented for her initial examination I evaluated both the involved and uninvolved side. Upon exam of the R side I found a weakness in the biceps and a bulge mid-biceps. I then went on and found her to have a positive Popeye muscle sign.[/QUOTE]Is this accurate? .......>You have been treating her for three months. She exhibited a Popeye sign on initial evaluation,three months ago, and now three months later still has a Popeye sign?
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Re: What to do? - February 6, 2007 4:00:00 AM
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Synergy
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I do agree with the latter part of JBird's response. You should contact the chiropractor and relay your findings ASAP. This is something you shouldn't just wait out, although it does appear (as Jeep surmised) that you already have.
This doesn't look like a chiro-bashing attempt to me either...just a concerned PT looking for answers. Chill!
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Chris Adams, PT, MPT
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Re: What to do? - February 6, 2007 4:10:00 AM
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Marc Bronson
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Diane, give it a break, no health professional, unless they are totally into S&M, deliberately tries to harm their patient. Whether or not this guy was incompetent or grossly negligent is another issue.
Dan, I would also call the DC in question and present to him your report of findings re: the patient, however, I think you will need CONSENT from your patient prior to doing any of this. Ultimately it is up to the patient to file a complaint with the College of Chiropractors for that State to formally proceed. Discuss the options with your patient and try to resolve it without getting into the legalities which is often times just as undesirable.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: What to do? - February 6, 2007 4:25:00 AM
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ptdan23
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You know what jbird007, I almost put a disclaimer in here saying that I am not trying to bash the chiros or anything like that. The intention of my post was to ask my colleagues for advice. Therefore I am asking the PT's on the board for advice. If you as a non-PT want to give your opinion that is fine but don't try to turn it into a PT vs DC issue.
Would it do much good to talk to the chiro who possibly caused this? What are they going to say, yes I did it? I doubt it.
My main concern was that the chiro was treating her for her back and then without evaluating her shoulder her performed a treatment on the shoulder. That to me seems to be negligence.
I am just looking for some guidance so please lets keep the PT vs DC debate out of here!!!!
Dan C., PT MTC
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Re: What to do? - February 6, 2007 4:28:00 AM
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ptdan23
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Jeep...truthfully I have not been able to do a reassessment of the UE lately (2* to the problems she has been having w/ low back and L hip) but she had the popeye muscle on initial examination.
Dan C., PT MTC
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Re: What to do? - February 6, 2007 4:31:00 AM
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ptdan23
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Marc...I guess I will definitely have to consider calling the chiropractor in question. The one reason I have contemplated for so long on what to do is that I did not want to get into any legalities of it. While the patient did seem concerned and seemed to be aware that she started having problems after the chiropractic manipulation of her shoulder she did not tell me she wanted to file a complaint. On the other hand I am not sure if she is aware that this is an option.
Dan C., PT MTC
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Re: What to do? - February 6, 2007 4:33:00 AM
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FLAOrthoPT
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as someone said before, you can relay the story without YOU drawing conclusions...you were not there to witness cause and effect. Relay the information to the referring doc, let them know the patient's story, your clinical observations, and leave it at that. Just because someone says treat my ankle, doesn't mean I am negligent looking at their back. We are a big system of interconnected parts, I think there was a song about it...
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Re: What to do? - February 6, 2007 4:33:00 AM
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dfjpt
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[QUOTE]Diane, give it a break, no health professional, unless they are totally into S&M, deliberately tries to harm their patient.[/QUOTE]Hello? Most practitioners (of any stripe) solemnly believe they are treating mesoderm, which mysteriously misbehaves and causes pain, and that their job is to round it up, push it around into some sort of "correct" configuration, and hope it stays put. Attempts to push mesoderm around, no matter how well-intentioned, lead to harm. Inadvertent, but harm nonetheless. Surely no one disagrees that harm can happen from being too forceful. I'm saying the belief system is all wrong in the first place - it's based on ideas about pain that are 400 hundred years old, for pete's sake, and treatment ideas that are older than that, that fossilized about a hundred years ago around the same time chiro did. Time to stop all this forceful treatment overkill, IMHO, straighten out the thinking a bit better, update it to the current century and current pain/neuro science.
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Re: What to do? - February 6, 2007 4:38:00 AM
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Jeep
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Dan-
My honest opinion on this---- you should have gotten her back to the orthopod for evaluation three months ago.
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Re: What to do? - February 6, 2007 4:45:00 AM
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ptdan23
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Jeep...she was not referred to me by an orthopod, she was referred to me by her PCP. I did not refer her to an ortho because at her age they would not have done anything as far as surgical intervention.
Dan C., PT MTC
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Re: What to do? - February 6, 2007 4:47:00 AM
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ptdan23
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FLAOrthoPT...I am not saying that he was negligent because she was being treated for her back and he did something with her shoulder. I said this because he did not evaluate and examine the shoulder prior to performing a treatment. This is like someone coming to you for their shoulder and they tell you they have back pain and then right away your perform a thrust manipulation of the LS without first examining mobility, etc.
Dan C., PT MTC
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Re: What to do? - February 6, 2007 4:50:00 AM
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Jeep
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[QUOTE] because at her age they would not have done anything as far as surgical intervention. [/QUOTE]If this were my patient, regardless if I felt the above to be true, it is not my call. That is for the orthos to evaluate and decide.
My responsibility/obligation to this patient is to make the referral.
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Re: What to do? - February 6, 2007 5:30:00 AM
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ptdan23
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From: Orlando, FL
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If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?
Dan C., PT MTC
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Re: What to do? - February 6, 2007 5:35:00 AM
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jbird007
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Dan, I would hope you have a "superior" to discuss this matter and other situations that may arise.
You could be held accountable for not doing anything and for continuing to treat the pt.
I hope in your practice you never injure anyone beacuse the risk is definately there. Handling the case ( quickly,efficiently and professionally) is of utmost importance.
JBird
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Re: What to do? - February 6, 2007 5:37:00 AM
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jbird007
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quote:This is like someone coming to you for their shoulder and they tell you they have back pain and then right away your perform a thrust manipulation of the LS without first examining mobility, etc.
Dan, just because you "examined" it for mobility does not eliminate a possible injury.
JBird
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