The painful shoulder: an update on assessment, treatment, and referral.

Abstract

Shoulder pain is the third most common musculoskeletal presentation in primary care after back and knee pain. Annually 1% of adults are likely to consult with new shoulder pain. The four most common underlying causes are rotator cuff disorders (85% of cases), glenohumeral disorders, acromioclavicular joint (ACJ) pathology, and referred neck pain. Although the vast majority of cases are treated satisfactorily, chronicity and recurrence are common, with estimates of 14% of patients still consulting 3 years on. Look for the following red flags that indicate the need for urgent investigations and/or referral to secondary care: acute presentation with a history of trauma (especially if pain restricts all passive and active movements); systemic symptoms such as fever, night sweats, weight loss, or new respiratory symptoms; abnormal joint shape; local mass or swelling; local erythema over a ‘hot’, tender joint; and severe restriction of movement. Enquire about the following: The focus should be on the four most common problems. Appendix 1 will help guide diagnosis, treatment, and referral decisions. None of the many specific clinical …