Physical therapist recognition of signs and symptoms of infection after shoulder reconstruction: A patient case report

Study design: Patient case report. Background: Clinical reasoning associated with patient evaluation leads physical therapists to one of three choices: 1) treat; 2) treat and refer; or 3) refer. Patients seen postoperatively require screening for potential complications, including infection. Inconsistent or unusual signs and symptoms following orthopedic surgery should lead to consultation and referral, and modifications to the physical therapy plan of care. Case description: A 35-year-old female with Type II glenohumeral instability was referred to physical therapy 5 weeks after a capsular shift surgical procedure of the right shoulder. During the initial physical therapy examination, unexpected complaints were noted including bilateral diffuse multi-joint arthralgia as well as fatigue that significantly limited the patient's abilities and functions. These and other atypical signs were recognized by the physical therapist as indicative of a possible infection or other type of medical complication. Recognition of the atypical findings led the therapist to immediately contact the referring physician, an action which influenced the timely addition of antibiotic therapy. After antibiotic therapy was added to the medical care of the patient, she was able to fully participate in postoperative rehabilitation and successfully completed postoperative rehabilitation within the expected time frame. Discussion: This case illustrates the importance of physical therapists recognizing and reporting atypical signs and symptoms during postoperative care. Prompt communication between the physical therapist and the referring physician in this case led to appropriate medical management in the addition of antibiotic therapy that facilitated patient recovery.