CSobsessed
Forum Senior
Topics: 6
Posts: 144
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elenita, I think it will be OK to roll up sleeves, "good" shoulder first. You are fine as long as you do not palpate through the fabric ,keep the patient as much covered as possible to preserve his/her dignity and tell him/her what you are going to do before you do.
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| d_raza1
Forum Senior
Topics: 32
Posts: 92
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i think in male patient, u should ask the patient to take off shirt so that shoulders are visible from each angle and visible completelty. in females they perhaps will not put a case of shouldr problem, if they do u can tell the examiner that prhaps a sleevless shirt would be better.
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| md2besoon
Forum Elite
Topics: 33
Posts: 228
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do it exactly like you will do examining a shoulder of your loved one.
___________________
Service to others is the rent that you pay for your room here on earth.
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| ruiz
Forum Newbie
Topics: 0
Posts: 9
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Took the Exam in ATL in August 20 (already have the result)
You know I can not talk about what Patients I HAD during my exam... But let me give you a couple of suggestions about the Shoulder pain patient.
Remember to ask about the pain, and all its components, Location, Intensity, Quality, Onset, Radiation, Factors that Alleviate or Aggravate the pain, and Other associated factors, ask also about how the pain started and if there was any associated factors, like trauma for example. Ask for the patients ocupation and if that ocupation has any type of stress over the joint, like "What is your ocuppation?" "Do you have to lift heavy objects or do a repetitive work with your arms?" Ask the patient if there is pain in any other area of his body, and look for signs of Osteo Arthritis. Finish the questioning as usual.
Physical:
While you wash your hands let the patient know that you are going to examine the shoulders, begining with the one that is not painful, and tell him something like: " I know you are in pain, I will be very carefull during the examination, if you feel pain with any manouver, please let me know" -- Remember drapping technique.
Do this in Both sides starting with the one that is not painful:
Unbotton the Gown on the shoulder that you are going to examine... Remember to ask patien if this is ok with him.
inspect the shoulder, palpate looking for deformities, temperature changes or coloration,
let the patient know that you are going to move his arm and remind him to let you know if there is any pain. First move the joint in Abduction, Adduction and Rotation, ask the patient to do the same movements him self, ask the patient to touch the oposite shoulder with the tip of his fingers, test strength on shoulders at least on Abduction adduction and test brachial reflex. Drap the patient.
Proceed with the other shoulder Same story. Most likely the patient will exhibit pain in at least two of those manouvers, remember to LOOK at the PATIENTS FACE, not the shoulders while examining. By this moment the 5 Minute allarm will sound.
Do a check on the rest of systems, just Cardio and lungs and a very brief abdominal exam will do. Drap the patient as appropriate.
Remember to sumarize and counsel the patient to avoid lifting heavy objects, offer to write a note to the patient's employer with the patient's permission if necessary.
REMEMBER TO COUNSEL on tobbaco use even in this cases.... that is a common trick here.
Get out and write the note.
Gabriel Ruiz, MD
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