Examination of the shoulder joint
Sports Medicine obviously tends to have relatively more acute, traumatic and mechanical problems happening among younger patients.
Older patients obviously tend to represent more of the chronic and degenerative problems, but not exclusively so.
A particular joint may have similar symptoms but which can be caused by different pathologies. It is the GP’s role to disentangle the diagnoses and implement the evidence-based management appropriate to the individual patient.
The NHMRC evidence guidelines relate to acute musculoskeletal pain and may not always be applicable to chronic problems.
There is considerable evidence in the Cochrane Library relating to shoulder problems. General Practitioners do not restrict themselves to a particular joint or a particular pathology.
Shoulder Problems may include
Dislocations Ligament injury Arthritis
Tendon tears Fractures Bursitis
Tendonitis Impingement Capsulitis
Myalgias Referred Dysfunction
10% of adults will experience an episode of shoulder pain. It follows low back and neck pain in incidence.
The vast majority of patients with shoulder pain are treated in primary care settings.
Many cases of acute shoulder pain resolve spontaneously regardless of treatment. 23% resolve within one month and 44% within three months
Evidence based management of acute musculoskeletal pain a guide for clinicians
There are numerous studies regarding the evidence about the diagnosis of shoulder problems (especially the use of ultrasound) and the effectiveness of the various treatment modalities (injections, NSAIDs, physical therapies, surgery etc).
The evidence tends to show that symptoms and physical signs do not correlate sufficiently for definitive diagnosis of shoulder pain. For a summary of shoulder examination see the summary.
Ultrasound appears to be very sensitive and specific for identifying full-thickness tears of the rotator cuff according to some, but not all, reports but not so useful for detecting partial thickness tears, with sensitivity of about 70% and specificity ranging from 29% to 96% in different reports.