Wednesday, August 19, 2009

Dislocated shoulder

It's been 6 months since I dislocated my shoulder and am still suffering some pain and discomfort. It's on and off so it has not been enough to drive me to see an orthopaedist yet. Had 3 months of physical therapy and have been continuing with the exercises.

My original impression was that a dislocation was easier to heal than a broken bone but now I'm not sure. Too many movies where the protagonist just shrugs his shoulder back and goes on to fight the bad guys, I think. The muscles around the shoulder seem to be the source of the discomfort rather than the shoulder itself.

Physical therapy itself is a bundle consisting of warm up exercises (1/2 hour), electrical stimulus (1/4 hr) and PT (1/4 hr) with a human. Electrical stimulus helped in the first week of treatment but after that its effect was negligible. Googling for randomized trials of the efficacy of electrical stimulus seems to indicate that it is effective only for cases of high pain. If insurance wasn't paying for the treatment I probably would have refused electrical stimulus. So if I were asked if I had been overtreated , I would probably respond with a cautious yes.

When I first entered the ER the shoulder was X-rayed and then after the shoulder was back in place, it was X-rayed again. I don't believe there was any over-treatment here. Moreover, instead of physician services, I received a physician assistant who worked out just as well (and probably had a better bedside manner). The bill however was from the physician whose rates were not the same as the rates from the insurer so I had to cover the difference. While I was not over treated, I was definitely over billed!

A follow up visit was to an orthopaedist who took another X-ray. I thought it was necessary given the decentralized system of medical care but in a centralized system it would have been just as effective if the post repair X-ray from the ER had been forwarded to him digitally. I barely spent 15 minutes with him and again not over treated but definitely over charged. (Assume doctor's rates are over $150 per visit - not quite unlike a plumber's rates the moment he steps through the doors!)

The first month of PT did not go as planned because there was some suspicion of scar tissue which required a cortisone shot. There was a real desire on my part to have an MRI to confirm the presence of scar tissue but this really would not have changed the treatment and to the orthopaedist's credit he did not require an MRI. It's not unlike a plumber who wants to send a camera into our drain to see what was causing the block - the fact that there is a block means that the treatment really doesn't change - they need to snake it out regardless of what they see on the camera. (Trust me after falling for this scam I won't be having a camera snake through our drains again!)

So overall, the dislocated shoulder's contribution to the overall economy was modest but not insignificant.

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