Shoulder pain in primary care: frozen shoulder

Abstract

BACKGROUND AND CONTEXT: Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM:Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management.RESULTS: Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT:Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS:Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year.

A randomized controlled trial of ultrasound-guided pulsed radiofrequency for patients with frozen shoulder

“…[4–6] It has been reported that this condition can affect 2% to 5% of the general population, mostly among the female population between 40 and 65 years old. [7–11] A variety of studies tried to explore its mechanism. [12–14] Unfortunately, it is still unclear.…”

To Determine Preference of Shoulder Pain Management by General Physicians in Lahore

“…Ultrasound scan or imaging were the most commonly investigations made. So when they treated once the diagnosis made according to the standard clinical guidelines then their patients came with significant clinical difference and the functional improvement [22]. So we concluded that general practitioners refer their patients to the physiotherapist and generally they recommend the x-ray for investigation.…”

The Role of Physical Medicine and Rehabilitation in Shoulder Disorders

“…Frozen shoulder, or adhesive capsulitis, is a painful and disabling condition of unknown etiology caused by a spontaneous contracture of the glenohumeral joint in absence of an evident previous event, resulting in reduction of joint motion [71]. This debilitating condition affects from 2 to 5% of the general population [72] and its prevalence increases to 10-38% in patients with comorbidities, such as hypothyroidism [73], diabetes, increased body mass index and cervical spondylosis [74].…”