Patient Chronicles : Shoulder Surgery Edition

What if X-Ray Studies don't tell the whole story? How do you paint the clinical picture?

Follow along with my patient’s journey as he navigated the traditional healthcare / physical therapy model and how he found the out of network model. 

Patient’s name has been changed to maintain patient privacy - The patient will be referred to as Jim in this story.

We all have a story. At my clinic, I am privileged to hear countless stories of success, struggle, and perseverance. These stories all share commonalities; however, are evidently unique as every person navigates circumstances that add to or subtract from their journey.

Below is the story of “Jim” and how he found my clinic following a surgical procedure on his right shoulder…

Jim's Story

I received a phone call one Friday afternoon as I checked into a hotel in the Dallas/Fort Worth metro region for a continuing education seminar. When I answered the phone, I was greeted by a man who was very pleasant - however - obviously frustrated and looking for answers. 

His first few questions all hovered around the concepts of:

• “Can you help me?”

• “Do you spend one on one time with your patients?”

• “Do you do Hands-On work every session? Because I can do exercises on my own…”

As I listened intently to his questions, it was quickly evident that he felt he had experienced sub-par treatments along his journey and is now looking for something different - something more.

He proceeds to tell me a little about his symptom background, which includes a 10+ year history of fluctuating and stabbing shoulder pain. He states he is 48 years young and incredibly active, including being a competitive tennis player and exercise programs including P90X on his tennis “off days.” He lamented that over the past 6 months, his shoulder pain was beginning to limit his ability to both play tennis and exercise, which began to affect his mood and quality of life. 

So he did what he was “supposed to do,” or at least what he thought he was supposed to do. He called his primary care physician and made his appointment for shoulder pain. This initial phone call resulted in a few week wait for an available appointment, all while he continued to take anti-inflammatory medications to mask his symptoms as he pushed through tennis matches and workouts.

When his appointment date finally arrived, he was quickly whisked through his visit and ended up at the X-Ray room to take a closer look at what is causing the “stabbing” shoulder pain. 

Upon receiving his X-Ray results, he was diagnosed with AC Joint Osteoarthritis and his physician stated this explains his shoulder pain.  

He was referred to an Orthopedic Surgeon who recommended a surgical procedure for the right shoulder. Jim was informed that the surgery has a quick recovery time and he would be back playing tennis in a few months - without pain. 

This obviously excited Jim since the procedure would both address his pain and minimize time away from tennis. 

So he underwent a Right Shoulder Arthroscopy (“scope”) which included a Subacromial Decompression / Distal Clavicular Excision and when choosing surgical procedures based on Jim’s x-ray results - these techniques are appropriate choices. 

Following a successful surgery, Jim was referred to begin Physical Therapy at a nearby clinic both recommended by his surgeon and within his insurance plan. He could finally start to see his comeback taking shape!

But this is when noticeable problems began for Jim…

He attended 2 sessions of Physical Therapy, with the first session being the initial evaluation. 

While still on our initial phone call (At this point, I am still yet to meet Jim and he has not scheduled his session with our clinic - I am simply giving him the space to tell his story), he revealed that the initial assessment was rushed and very vanilla. He explained the evaluation lasted roughly 30 minutes and only surface level questions were asked. Although he mentioned to his therapist that he also had groin/hip pain during tennis, they said they can only treat his shoulder right now because “that's what the doctor ordered” and if the hip/groin pain is still bothering him in a few weeks, they could try to get a referral. It was explained to him that his treatment would start next time as they put ice on his shoulder - signifying the end of the first session. 

So he eagerly waited for his first follow up and he stated this session was equally unimpressive. He shared that he received heat on his shoulder, then worked through a few stretches and exercises with an assistant (not a licensed therapist) without first seeing his Physical Therapist. When he was finally able to see his Physical Therapist, he revealed he received about 10 minutes of hands on treatment before getting ice on his shoulder. 

He was not happy. He knew there had to be more. And what about his hip?

As I digested this information on the phone call, I explained to him that what he experienced is unfortunately a common experience I hear from many patients. And it is because of this, I created our model of Physical Therapy where every session is 60 minutes of uninterrupted time with your Physical Therapist and we perform extensive - as appropriate - hands on manual therapy at every session (in addition to corrective exercise prescription based on diagnosis). 

Jim quickly scheduled his initial evaluation and we began early the following week. 

Over the next few weeks, he was very pleased with his session structure and his post-operative progress, with progress initially being dictated by surgical healing. He progressed as expected while we performed proactive treatment for common concerns that can occur away from the surgical site (elbow/wrist discomfort, mid spine tightness, upper trap tightness, and neck pain). Not to mention, we were able to provide treatment to his hip/groin pain that the previous clinic dismissed because we were treating Jim via Direct Access. 

We quickly progressed to the fun stuff - Functional Shoulder Exercises!

But a problem occurred, despite undergoing a surgery that literally removes the pain generator for AC Joint Osteoarthritis, his sharp pain was still present.

Only now, since Jim has more range of motion than at his initial evaluation, we were able to appropriately assess the neck and associated neural system.

And guess what - his initially reported pain was reproduced with pain provocation testing to his neck and, specifically, his median nerve. 

The exact pain, in the exact spot, with the exact same sharp pain quality. 

This immediately caused a pivot and shift in the treatment plan, because now we are uncovering the true source of his symptoms; however, we still have to respect the (seemingly unnecessary) post-operative status of his right shoulder. 

Now, with the pain generator in sight, we were able to provide the appropriate Osteopractic treatment techniques to the joints in the neck, neural system, mid back, and more as exponential progress was made. 

We were able to quickly resume functional, sport specific exercise (tennis) and he returned to the tennis court with minimal shoulder-related setbacks. 

Jim would ultimately progress through his formal physical therapy program and eventually graduate to a proactive wellness program where we provided general mobility training, education specific to him, and general strengthening to allow Jim to stay active and avoid further injury. 

His wellness sessions were ripe with in depth questions on how to avoid injury, and how certain injuries can create imbalances/compensations. He routinely made remarks that the educational/conversational component of his wellness sessions were invaluable as he was afforded the time to ask questions no one else would answer to avoid new injuries/avoid setbacks.

I am genuinely happy to say this, despite the normal aches and minor soreness associated with an active lifestyle, Jim is currently enjoying the ability to play tennis without complaints of shoulder pain or discomfort. 

Moral of the story for Jim - and what we can all take from Jim’s Story:

Jim did exactly what he thought he was supposed to do. He went to his primary physician (who is not an expert on the neuromusculoskeletal system - but rather the gatekeeper to refer to other providers as necessary) where he explained the symptoms he was experiencing (shoulder pain). It wasn’t Jim’s job to say a magic word to trigger suspicions of the neck being the generator - that is the medical provider’s job to suspect and identify underlying causes. He reported his symptoms and was subsequently rushed through standardized imaging studies for his shoulder. 

The problem is that the resulting image did not accurately portray the clinical presentation. Sure, it matched the “sharp” pain described. But without a comprehensive screen of the structures of the shoulder and the neck, then the usefulness of an X-Ray is limited. 

This X-Ray revealed what many 48 year old, active adults likely have - Osteoarthritis (You may know this as, “bone on bone”). Based on this, a decision was made to have a surgery to remove the arthritis - which unfortunately ended up being an unnecessary procedure.

Stories such as Jim’s illustrate the benefits of a comprehensive Physical Therapy assessment utilizing Direct Access to be seen the same day by a Doctor of Physical Therapy. Doctors of Physical Therapy, notably Osteopractic Physical Therapists with a Board Certification in Orthopedics, are regarded as the experts in the neuromusculoskeletal system and can accurately identify the source of your symptoms, as well as provide appropriate treatment strategies to address your symptoms. 

Had Jim known that he could circumvent the antiquated, insurance-driven healthcare system, and have his symptoms assessed by a Fellowship trained Osteopractic Physical Therapist initially, then a surgery could have been avoided and symptom resolution could have been achieved significantly sooner. 

Stories like this, Jim’s Story, are not one in a million. I hear versions of this weekly, even daily, where people call with striking similarities of misdiagnosed knee pain or recurrent heel pain or headaches that affect computer work and chewing. 

So if you feel like you are alone with your story, you aren’t. If you are frustrated because your pain keeps coming back, don’t be. If you have ever felt dismissed or invalidated by your provider because they can’t identify why your symptoms are present - then the root cause simply hasn’t been addressed yet. 

Flow Physical Therapy in Lafayette, LA provides 60 minute, uninterrupted Osteopractic Physical Therapy treatments to address the root cause of your pain and answer your questions - even if you’ve tried Physical Therapy in the past or felt dismissed by the healthcare system.  

If you think you need a closer look at your stubborn symptoms with a provider willing to give you the floor, click the button below to get started and get back to your pain free lifestyle.

Click Here to Get Started

Side note: If any of my past patients named Jim think this story is about you, it's not. The patient chronicled  in this story's real name is !

Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT

Owner of Flow Physical Therapy and Wellness

337-366-1703