And why not...more about pain

Just in case any of you were feeling any doubts about what y0u are doing out there, a little story to remind you 1) How well we have been trained and 2) Just how important physiotherapy is

My newest patient is a middle aged lady who suffered a comminuted and displaced fracture of the proximal humerus after a fall. Surgical management, 12 days in hospital post op due to oozing wound. She presented (7 weeks post fall) the other day with severe pain in the anterior shoulder on movement and a 6/10 resting ache that worsened during the day. Additionally, she had alot of swelling in the entire arm (affected hand 2-3x the size of unaffected). Her referral from the surgeon read "decreased ROM in R arm. mobilise aggressively".

OK so firstly to the how well we are trained part. Here was model of the patient that the staff (particularly Evan) told us about in terms of antalgic positioning causing secondary complications. Due to immobilisation in a sling for a number of weeks, the patient had lost ROM in the shoulder, elbow, wrist and hand. Also, due to the collar and cuff sling she had prescribed herself, she was experiencing severe neck pain. Objectively PROM was severely pain limited in the shoulder and the elbow. However, when I was teaching her pendular exercises I noticed that she was able to gain significantly more shoulder and elbow ROM. Bending at the waist during pendular Ex's meant she could achieve 70 degrees shoulder flexion pain free. AND... when she stood back up she was able to actively lift her soulder and arm to hold in the sling position, without the sling. Hmmmmm... Now, me noticing this is not something to brag about. Anyone with our training would be able to match a number of her symptoms with her antalgic behaviours. Which brings me to my second point.
Why is physiotherapy so important in this case? Because in the nearly 2 months since her fall, I was the first physiotherapist she had seen. I don't really see how that could be possible, but that's not the point. If she had been seen by a physio, her problems might not be the same now.
Cheers
M