what exactly are the things done for a shoulder fce

[rhea_l]

I had a right shoulder operation in August, 09. I am contesting a return to work order with no limitations. I am an ICU Nurse, we are required to lift, pull and turn patients every two hours. I am being sent for an FCE. What should I expect to see or do during the evaluation?

[sjcatone]

Why do they not take pain into consideration during an FCE? And also during PPD settlement? I too am an ICU RN and injured both labrums and had 2 surgeries and 2 manipulations. 8 and 1/2 months later, I am able to raise my arms up, but lifting 3 lbs is an effort and internal and external rotation are quite painful. I have had chronic pain since Februrary, and I'm trying not to take pain meds unless it's unbearable. FCE probably will be scheduled for end of October and I'm scared to take it. I'm told if you don't get 70% it's deemed void.

[Tuckamore]

Thank you for the update. It was very interesting and educational.

I had a similar one done some years ago but there were no cameras. I would imagine the computer calculation would lessen the chance of human error. or human instinct and subjective conclusions.

IME (Independent Medical Exam) may or may not be required. Again I would imagine that this may take the place of an IME.

I hope you will let us know the results. How do you feel you did...and the outcome?

[rhea_l]

FCE done 12-15-2009.
A physical therapist and a bio-engineer administered the test. I was made to wear a black tank top, that was for better film results. There was a camera to capture all the movements, and to enhance the outcome of filming, small bulbs of light were attached to the limb being tested and to the side of my body facing that limb.

The first test was more towards history of the injury, including what hobby I was unable to do after the injury. I should have said swimming with the kids instead of gardening. They also asked me which doctor did  I see first.

The next test was grip strength measurement, both left and right, at 3 different grade of distances. My right hand grip was significantly decreased at the widest distance of the measuring device. My left was 27 to 32. My right was 5 to 8. My BP was also taken after.

After , the small and round light bulbs were attached using a "sticky pad" similar to an ecg lead. Both limbs were tested alternatingly, facing the camera. I picked up a plastic stepping stool. I bent at my knees and the physical therapist said " good technique". It made me wonder is that being observed also?

A series of ROM of the upper extremities were tested.  I picked up a plastic stepping stool, had to go up and down the stepping stool on alternating foot.

Then I had to step atop a platform, tug and pull on a rope, first facing the wall then they had my back to it. The results will come out in a week. The numerical values will all be calculated by computer if I understood them right. YOu mentioned IME, will the method used on me lessen the chance of human error?

[Tuckamore]

Yes it is more probably than not that they do not repair a partial tear of the rotator cuff.  Much will depend on the individual and the severity of the injury. Professional athletes have repairs as well as the very young.

I had/have one about 18 years ago and it was not repaired. It was very painful for about 7-8 months but gradually improved. I continued to have pain and problems with it for about three years. Now all these years later only repeated overuse will bring the pain back and it is never sharp or severe.

I know your duties as an ICU Nurse. You may find them difficult if you return at this point. There are alternative ways to perform some of your duties but with both shoulders involved it will be challenging to say the least.

I hope they will allow you more time to rest the injury. If not can you change departments? Although I know that most nursing hospital positions require some degree of lifting and pulling.  

Your left shoulder is most likely not a rotator cuff tear. It sounds more like an inflammatory process from over use therefore should not require a surgical intervention.

When is your FCE scheduled? Please let us know the outcome. I am sorry that you have had to face so many challenges with this injury and suffer so much pain.

Tuck

[rhea_l]

thanks,
this is a very valuable piece of info for me. The operation is a simple debridement. The tear of the rotator cuff and labrium was left unrepaired. According to the surgeon, it is less than fifty percent, therefor he left it. The pain four months later is worse after the operation and my range of motion is limited. This is the frustrating part. The left shoulder is showing signs of stress from compensating for the right. A steroid shot was given for the left.
Is it customary for a tear to be unrepaired? Given the same symptoms of the left shoulder, am I headed for another surgery for the left shoulder too? The work demands as a nurse will not change. I will have to lift pull and turn heavy patients.

thanks,

Rhea_l

[Tuckamore]

Hi Rhea,

Welcome to the Pain Management Forum. I am glad that you found us. I know the challenges of your position.

A Functional Capacity Evaluation should be fair in measuring your capabilities no matter who may administer it. At least one would hope that is a fact. One of the things they will look for is signs of malingering and the effort that you put forth during th exam. The thing that they can not observe is obviously the subjective factors, such as how high is your pain level post activity. The evolutions in those areas can only be based on objective factors.

Who is sending you for the exam? Was the surgery successful and did you have an uneventful recovery? Those facts should be taken into consideration during the FCE.

If this was a work injury I would be concerned that it may be slanted if it is not conducted by an IME.  Best of luck to you. I hope you will recover completely from the surgical repair. Please let us know how you are doing. We all learn from one another.

Peace,
Tuck