The course of pain and the restriction of mobility in patients with shoulder complaints in general practice

Abstract

The objective of this research was to study the course of the pain and the restriction of mobility of the scapulohumeral joint (ROM) over time, and the factors influencing it, in patients with shoulder complaints in general practice. A total of 101 patients participated in this 25-week follow-up study. For the first 2 weeks, a non-steroidal anti-inflammatory drug (NSAID) was prescribed, after that period the physician could follow his usual therapeutic approach. The NSAIDs prescribed during the first 2 weeks resulted in a rapid decrease in the pain and the ROM. The group with the most severe pain consumed the most tablets, which resulted in a significant decrease in the pain and the ROM. It appeared that the course of the pain from week 2 to week 8 was significantly influenced by pain at inclusion, diagnosis and therapy. The most rapid decrease in the ROM appeared in the first 2 weeks. At week 0 and week 2, differences, in the ROM were seen in the subgroups for diagnosis pain score and age. The pain and the ROM showed most decrease in the first weeks. After 6 weeks hardly any changes were seen in the pain score and the ROM score. The margin of the pain score and the ROM score between the "cured" and the "not cured" patients was a very narrow one.

Treating shoulder complaints in general practice

“…The only "retrospective" element arises from the necessity that long term symptoms must have already occurred before they can be ascertained. Our report of a strong relation between epidural anaesthesia and subsequent long term backache was based on far more women and far more follow up years than all subsequent reports put together, [3][4][5] and the finding remains valid.…”

“…3 The nurses' health study of nearly 60 000 women studied over more than 600 000 person years has shown a large decrease in the risk of major coronary heart disease among women taking hormone replacement therapy. 4 Hemminki and McPherson's paper fails to contradict that finding. The three cardiovascular events attributed to the 1973 paper by Aitken et al 5 relate to a high dose of the oestrogen mestranol, which has not been used for over 20 years.…”

“…Thus the number needed to treat with hormone replacement therapy for 10 years to prevent one death was 54, compared with 70 for mild hypertension. 4 Even if it did not benefit patients through good effects on menopausal symptoms and osteoporosis, hormone replacement therapy seems to be a good public health measure for women.…”

A simple classification system was recommended for patients with restricted shoulder or neck range of motion

“…This suggests that it is sufficient to examine either the restriction in the passive or active motions, or the amount of pain. This suggestion is supported by a number of questionnaire development studies, where it has been deemed sufficient to record the amount of pain experienced by patients with shoulder complaints during performance of different activities in order to measure (perceived) recovery [19][20][21][22][23].…”

Mogelijkheden voor cognitief-gedragsmatige behandeling van schouderklachten in de eerste lijn

“…Het incidentiecijfer in de huisartsenpraktijk bedraagt 12 tot 25 per 1.000 patie¨nten per jaar (Lisdonk, 1994). Ongeveer 50% van de patie¨nten die met schouderklachten een huisarts heeft geraadpleegd, heeft na zes maanden restklachten en na twaalf maanden is dit percentage 40% (Windt,1996;Winters, 1997). Na lage-rugklachten vormen schouderklachten hiermee de grootste groep van klachten van het bewe-…”