Irritability

Irritability = pain severity + how long it takes for pain to appear + how long it takes to ease. We are taught that irritability will guide the amount of assessment we are able to do during the session. I am on my musculoskeletal placement and when we have a new patient we carry out our subjective then speak to our supervisor then return to do our objective.

My new patient has had an annoying shoulder pain for 3.5 years and has recently found out he tore his supraspinatous tendon. When questioning him on pain his levels they were relatively low 1/10 at rest and 3/10 with some movements like reaching for his wallet. The pain decreased immediately once he changed out of the movement. As the subjective continued I realized he has modified a lot of his daily activities so he just no longer uses his left arm. He just ‘puts up with it’ as he would say.

After I reported my subjective my supervisor asked me what objective assessment I planned on doing. I felt the patient had low irritability and therefore I was prepared to complete the entire shoulder assessment as indicated. My supervisor told me to continue and felt this was the appropriate thing to do.

As I began the examination asking him to move his shoulder the pain levels began to increase. The resting pain levels also started to increase. I could tell that this man was in more and more pain. He also complained of muscle spasm showing the body was trying to protect his shoulder. I had performed very little examination and it became more and more obvious that this man avoided using his shoulder over the last 3 years. Now that his shoulder was moving again it was very painful and irritated. I automatically gave him a rest and prioritized my examination into what tests/ assessment would give me the most information and him the least pain. My supervisor was happy with this adjustment and said this can be very common and that the remainder of the assessment can be collaborated over the following sessions.

From this situation I learned to be flexible and that is it important to be able to alter your treatment/ assessment plan as needed. Also your patient might not always paint a perfectly accurate picture of what is going on and so in depth questions in the subjective are needed to pin point the truth.