Primary Care Management of Shoulder Pain

Question 1

How may patients present to their GP?

Answer 1

Pain = neck, shoulder, upper arm 
Stiffness 
Deformity (e.g acromioclsvicular joint)
Loss of function

Question 2

What may be some features of the patient’s history?

Answer 2

Rarely history of trauma

Consider other causes = cardiac, gall bladder, coming from neck, polymyalgia

Question 3

What are some features of the examination?

Answer 3

Look = watch how patient undresses, asymmetry, deformity, scars
Feel = bony landmarks, tenderness, check Axilla
Move = abduction to check scapula, active and passive, external and internal rotation

Question 4

What are some investigations that can be done?

Answer 4

FBC, viscosity, x-ray, US

Question 5

How long do patients normally take to recover?

Answer 5

12 months

Question 6

What are some non-pharmacological treatments?

Answer 6

Explanation, mobilise, physio

Question 7

What are some pharmacological management options?

Answer 7

Short term NSAIDs

Local injections = depo medrone with lignocaine

Question 8

When should you refer patients?

Answer 8

If pain isn’t resolving, instability, stuck

Question 9

What are some common shoulder problems?

Answer 9

Rotator cuff problems = especially supraspinatus tendonitis (aged 35-65)
Sub-acromial bursitis
Acromioclavicular disease = trauma in young, arthritis in older

Question 10

What are less common problems?

Answer 10

Frozen shoulder = age 40-60, more common in diabetics
OA/RA of shoulder
Recurrent dislocation