Prevalence of shoulder pain - adults7% overall26% in elderlyOnly 20-50% present to primary care1% of primary care consultations20% referred to secondary careOver 50% only 1 consultation

Rheumatology 2006;45:215221

Rheumatology 2006;45:215221

GP 1 Diffuse pain in upper arm, spontaneous onset Hawkins impingement +vePainful arc

Subacromial impingementPhysio

Sees physio - 2 weeks laterPhysio examines patient - tendonitisStarts treatment, pain gets worseRefers back to GP some biceps signs

Biceps tendonitis ? Slap tear

GP 2Unable to sleepDifficult to examine, slightly reduced ROMWeakness of shoulder ? Rotator cuff tear Refer specialist ? Needs MRI

Impingement

TendonitisProblem biceps tendon SLAP tear

Rotator cuff tearSpecial scanGetting worseCant sleepChew arm off

Thank you for the referralPain in shoulder last 4 - 6 monthsPhysiotherapy made it worseLimited ROMNo External rotationNormal x raysNo need for scan

FROZEN SHOULDER

VOL. 85-B, No. 6, AUGUST 2003

J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34175

.. Perhaps this patient needs an MRI scan60-69 =30% FTRCT70-79 = 50% FTRCT80-89 = 80% FTRCT1930 - 83Age-related prevalence of rotator cuff tears in asymptomatic shoulders; Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg 296-2991940 - 731953 - 60

104 shoulders chronic, atraumatic shoulder painHistory, physical examination, radiographs41% had pre evaluation MRI scans Majority of pre-evaluation MRI scans had no impact on the outcome90% no valueRoutine pre-evaluation with MRI does not appear to have a significant effect on the treatment or outcome

JSES 2005;14:233-237

Arthroscopy: Vol 26, No 3 (March), 2010: pp 393-403

CommonMost get better on ownTimeAnalgesia - NSAIDIf not better by 3 months refer?

BMJ. 2005 Nov 12;331(7525):1124-8

Coming from shoulderReferred, neckInstabilityRotator cuff, ACJImpingementTear (degenerate)Tendonitis (calcific)GlenohumeralArthritisFrozen shoulderBMJ 2005;331:11248

< 20 years20 40 years> 40 years Instability Trauma Labral pathology Biceps pathology Instability Tendonitis Frozen shoulder Rotator cuff dz Osteoarthritis Tumor

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