Monitoring Symptoms

On my current musculoskeletal outpatient placement, I have been treating a 43 y.o. male patient post right shoulder arthroscopy 3/12 who was previously treated well for his right shoulder ROM and strength which are close to normal now. However no improvements were shown over his last few treatment sessions with me as he reports increased weakness in his right upper limb and worsening symptoms of P&Ns and numbness in his right 5th digit & ulnar border of his forearm. On neurological examinations, he was found to have weak right hand intrinsic muscles, reduced sensation on right upper limb and mild hyporeflexia in his triceps, brachioradialis & pronatus quadratus tendons. NTPT via ulnar nerve was negative and other tests for all possible diagnoses including thoracic outlet syndrome were performed, and no significant findings were detected. I have seen this patient 3 times over the last few weeks and I felt that I have not been helping this patient to improve at all as he continued to complain of worsening of his symptoms each time he came in. After consulting my supervisor, my supervisor re-performed all the tests and results were same. The patient’s symptoms were flared up after double assessments done by me and my supervisor in the last session. After discussing with my supervisor, I was told to only do soft tissue massage on his tender shoulder area to help release pain. In terms of medical referral, my supervisor explained that his symptoms and the results from the neurological exams were not serious enough to get a medical referral. There is not much that we can do in terms of treatment but it is very important to keep monitoring his symptoms and therefore the best management for this patient is to educate him to monitor his symptoms at home and to keep track of his symptoms by re-performing the neurological examinations every time he comes in.