Shoulder disorders in general practice: incidence, patient characteristics, and management.

Abstract

Objectives-To study the incidence and management of intrinsic shoulder disorders in Dutch general practice, and to evaluate which patient characteristics are associated with specific diagnostic categories. Methods-In 11 general practices (35 150 registered patients) all consultations concerning shoulder complaints were registered during a period of one year. Patients with an intrinsic shoulder disorder who had not consulted their general practitioner for the complaint during the preceding year (incident cases) were asked to participate in an observational study. Participants completed a questionnaire regarding the nature and severity of their complaints. The general practitioners recorded data on diagnosis and therapy. Results-The cumulative incidence of shoulder complaints in general practice was estimated to be l l2/1000 patients/year (95% confidence limits 10-1 to 12.3).Rotator cuff tendinitis was the most frequently recorded disorder (29%). There were 349 incident cases enrolled in the observational study. Patient characteristics showed small variations between different diagnostic categories. Age, duration ofsymptoms, precipitating cause and restriction of movement seemed to be discriminating factors. Twenty two percent of all participants received injections during the first consultation; most (85%) were diagnosed as having bursitis. The majority of patients with tendinitis (53%) were referred for physiotherapy.

Isokinetic clinical assessment of rotator cuff strength in subacromial shoulder impingement

“…Forty to 60 year old participants were recruited to reflect the reported peak age for shoulder impingement (Ostor, Richards, Prevost, Speed, & Hazleman, 2005;van der Windt, Koes, de Jong, & Bouter, 1995). Symptom free volunteers as well as people with unilateral shoulder pain completed a screening questionnaire to determine their eligibility for this study.…”

Nonoperative Management of Common Shoulder Conditions

“…Pain is aggravated with overhead activities, lying on the affected side, reaching, pushing, pulling, or lifting. Patients may complain of not being able to fall asleep or waking up during the night secondary to pain [13]. Once a sufficient history has been gathered, a physical exam is necessary to aid in the diagnosis.…”

Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

“…Diercks et al (2014) highlighted the need for a combination of clinical tests in the diagnosis, and suggested the use of an imaging test after prolonged symptoms (of more than 6 weeks) to rule out rotator cuff tears. Shoulder impingement is a common cause of shoulder pain (van der Windt et al 1995, Urwin et al 1998). Tendinopathy is considered to have a multifarious etiology: intrinsic mechanisms may be more important than extrinsic mechanisms (Factor and Dale 2014).…”