Shoulder problems in General Practice

How to diagnose shoulder pain. Tips for GP's and physical therapists seeing patients with shoulder problems. www.shoulderspecialists.co.uk This presentation discusses features of common shoulder conditions, shoulder steroid injections and indications for early specialist referral. www.shoulderspecialists.co.uk Shoulder problems in General Practice- Transcript The purpose of today’s talk is to discuss some of the more common shoulder conditions which are likely to be encountered in General Practice So the first thing we need to decide is whether the problem with which the patient is presenting is a genuine shoulder issue or is it due to another structure. Features which may suggest that the shoulder isn’t implicated include pain in the neck, pain in the upper back, pain involving the whole upper limb, pain radiating along the collarbone or into the anterior chest wall or if paraesthesiae are a prominent feature. So what sort of features do you suggest that the pain is coming from the shoulder. Well, pain felt at the lateral border of the acromion or into the deltoid region is very characteristic of genuine shoulder pain. This pain is often worse when lying on the shoulder at night, when reaching up or out, or when putting the hand behind the back. So I’d just like to discuss a few rules of thumb which may make the diagnosis of shoulder issues a little easier. Firstly I think it's useful to consider that certain shoulder conditions are more common within certain age groups. For example, instability often in the younger age group these are often contact sportspeople such as Rugby players. Rotator cuff disease is essentially a disease of middle age most commonly. AC joint problems affect people with a broader age span. Frozen shoulder is again most common in the middle age group, particularly affecting women. Arthritis, not surprisingly, is a disease usually affecting the older age-group. Rotator cuff arthropathy is a particular type of arthritis affecting the older age group which arises as a result of chronic tearing of the rotator cuff. I'd like to discuss some of these common conditions in more detail now, firstly instability. Instability is actually, for the most part, fairly easy to diagnose. In general the patient will usually report a history of a significant injury and may well have attended Accident and Emergency following an incident. There are more subtle indicators of mild instability but these are beyond the scope of today's talk. So that’s instability The next thing we are going to consider is acromio-clavicular joint pain. The pain arising from AC joint issues is a little unusual in that it is felt at the AC joint itself, rather than the usual deltoid pattern pain, and may also radiate into the upper trapezius on the ipsilateral side. Patients tend to localise AC pain quite well and often feel it with overhead activities. There are some special tests for diagnosing AC pain which you can see on the relevant presentation. So we’ve dealt with AC pain and Instability. The next thing we need to decide is whether the patient is suffering from a subacromial (or rotator cuff) problem or is it a glenohumeral joint issue. The reason we do this is because the other common conditions can be grouped into one or other of these categories. ....CONTINUED TRANSCRIPT AND SUBTITLES AVAILABLE WITH VIDEO