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Decoding Shoulder Pain: A Comprehensive Guide

Understanding the complexity of shoulder pain from a medical perspective, with insights on prevalent conditions, referral procedures, and treatment options. Learn how age impacts shoulder health and the importance of proper examination techniques. Dive into the intricate world of shoulder problems with Dr. Jumbo Jenner, Dr. Andrew Ostor, and experts. Visit www.cambridgeses.co.uk for more details.

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Decoding Shoulder Pain: A Comprehensive Guide

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  1. Why shoulders are tricky Dr Jumbo Jenner Dr Andrew Ostor Miss Natasha Woodbine Mr Lee Van Rensburg February 2014

  2. www.cambridgeses.co.uk

  3. Prevalence • Prevalence of shoulder pain - adults • 7% overall • 26% in elderly • Only 20-50% present to primary care • 1% of primary care consultations • 20% referred to secondary care • Over 50% only 1 consultation Rheumatology 2006;45:215–221

  4. Rheumatology 2006;45:215–221

  5. Referral • GP 1 • Diffuse pain in upper arm, spontaneous onset • Hawkins impingement +ve • Painful arc • Subacromial impingement • Physio

  6. Physiotherapy • Sees physio - 2 weeks later • Physio examines patient - “tendonitis” • Starts treatment, pain gets worse • Refers back to GP some biceps signs • Biceps tendonitis ? Slap tear

  7. Referral • GP 2 • Unable to sleep • Difficult to examine, slightly reduced ROM • Weakness of shoulder • ? Rotator cuff tear • Refer specialist ? Needs MRI

  8. Patient Impingement Tendonitis Problem biceps tendon – SLAP tear Rotator cuff tear • Special scan • Getting worse • Can’t sleep • Chew arm off

  9. Specialist • Thank you for the referral • Pain in shoulder last 4 - 6 months • Physiotherapy made it worse • Limited ROM • No External rotation • Normal x rays • No need for scan • FROZEN SHOULDER

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

  11. 123 Tests

  12. 175 J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34

  13. …….. Perhaps this patient needs an MRI scan 1953 - 60 1940 - 73 60-69 =30% FTRCT 70-79 = 50% FTRCT 1930 - 83 80-89 = 80% FTRCT Age-related prevalence of rotator cuff tears in asymptomatic shoulders; Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg 296-299

  14. 104 shoulders chronic, atraumatic shoulder pain • History, physical examination, radiographs • 41% had pre evaluation MRI scans • Majority of pre-evaluation MRI scans had no impact on the outcome • 90% no value • Routine pre-evaluation with MRI does not appear to have a significant effect on the treatment or outcome JSES 2005;14:233-237

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

  16. Tricky

  17. Shoulder pain • Common • Most get better on own • Time • Analgesia - NSAID • If not better by 3 months refer? BMJ. 2005 Nov 12;331(7525):1124-8

  18. SHOULDER PAIN • Coming from shoulder • Referred, neck • Instability • Rotator cuff, ACJ • Impingement • Tear (degenerate) • Tendonitis (calcific) • Glenohumeral • Arthritis • Frozen shoulder BMJ 2005;331:1124–8

  19. Differential by age

  20. Examination

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