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665 - Interdisciplinary Medicine in Acute Inpatient Rehabilitation: The Value of a Musculoskeletal Consult in a Patient in a Disorder of Consciousness

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

SW

Sharon Woo, DO

PGY-3 Resident Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States

Co-Author(s)

KN

Kian Nassiri, DO

Brain Injury Attending Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States
SD

Sangeeta P. Driver, MD MPH

Section Chief, Brain Injury Medicine
Shirley Ryan Abilitylab
Chicago, Illinois, United States
Monica E. Rho, MD (she/her/hers)

Attending Physician
Shirley Ryan Ability Lab, Nothwestern McGaw
Chicago, Illinois, United States

Case Diagnosis: Shoulder Subluxation in the setting of Traumatic Brain Injury

Case Description: A 42-year old female with past medical history of a recent traumatic brain injury due to motor vehicle collision status-post decompressive hemicraniectomy and cranioplasty complicated by hydrocephalus with ventriculoperitoneal shunt in a disorder of consciousness is admitted to acute inpatient rehabilitation (AIR) for functional upgrade after previous rehabilitation admission. During her initial stay, the patient was found to have a left glenoid fracture. Orthopaedic Surgery follow-up after discharge recommended left shoulder sling for comfort without acute surgical intervention. On admission to AIR, patient was hemiplegic on the left side and demonstrated various pain behaviors with various attempts at passive range of motion, limiting participation in therapies. Repeat x-ray was obtained, which demonstrated further progression of inferior humeral head subluxation. Patient was ordered a McDavid brace, and Musculoskeletal Medicine (MSK) was consulted for additional recommendations.

Discussions: MSK evaluation was notable for severe subluxation on inspection and palpation. Bedside ultrasound evaluation did not show evidence for rotator cuff injury. Given severe degree of subluxation, patient was recommended to continue McDavid brace as well as initiate left arm sling to provide additional support. MSK also recommended neuromuscular electrical stimulation (NMES) targeting the pectoral and subscapularis muscles during physical therapy sessions. Patient was able to participate more in therapies and make significant progress towards her functional goals.

Conclusions: MSK consult provided us with recommendations that allowed us to address barriers preventing patient from engaging meaningfully in her therapies. It is valuable to have access to MSK consultation in the acute inpatient rehabilitation setting, especially in the setting of patients in a disorder of consciousness who have limited ability to communicate, to guide therapy goals and in order to fully maximize patient participation for improved functional outcomes.