Pattern and Physiotherapy Management of Shoulder Pain A 5-Year Retrospective Audit of a Nigerian Tertiary Hospital

Abstract

Shoulder Pain (SP) is a common musculoskeletal problem and it constitutes a source of referral and workload for physiotherapy. This study investigated the pattern and management of SP in a physiotherapy department of a tertiary hospital. A five-year case chart review (January 2005 to December 2009) of patients with SP referred to the outpatient physiotherapy clinic of University College Hospital, Ibadan, Nigeria was conducted. Data were gleaned on patients’ age, gender, occupation, referring diagnosis, physiotherapist’s impression, side of affectation, functional limitation, associated co-morbidities and impairments, pattern of treatment and outcome assessment tools. A total of 4.316 case charts were reviewed over the time period, SP accounts for 2.8% with a female to male ratio of 6:4. The mean age of the patients was 50.6±26.2 years and the age group for peak prevalence (43.8%) was 41-60 years. There was higher preponderance of left SP (51.2%) than right in the ratio of 5:4. SP resulted mostly from fracture (19.6%), osteoarthritis (10.7%) and dislocation (6.6%). SP led to functional limitation in personal care (23.1%), work (14.0%) and sleep (9.0%). The most prevalent musculoskeletal condition associated with SP was elbow pain (8.3%), knee pain (6.6%) and neck pain (5.0%) while hypertension (16.5%), diabetes (6.6%) and sickle cell (2.5%) were co-morbid medical conditions with SP. Reduced range of motion (73.6%), muscle atrophy (28.1%) and muscle weakness (27.3%) were the most associated impairments resulting from SP. Mobilization technique (76.0%), reciprocal pulley (62.8%) and hydro collator pack (62.0%) were often employed in the management for SP. The mean treatment duration of patients was 5.2±2.4 weeks. Outcome assessments were documented in 82.6% of the cases. Goniometer (28.9%), oxford muscle grading (19.0%) and verbal rating scale (15.7%) were the most frequently used assessment tools. Shoulder pain is not an uncommon condition presenting for physiotherapy among Nigerian patients and it constitutes a small burden on the physiotherapy care at a tertiary hospital. The pattern and management of shoulder pain in this study is similar to findings from previous studies from around the world.