1. Why shoulders are tricky Spire - BRidge
Mr Lee Van Rensburg
Mr Niel Kang
March 2014

4. www.cambridgeorthopaedics.com office@cambridgemedicalpractice.co.uk
Rheumatology 2006;45:215–221

5. 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

6. Rheumatology 2006;45:215–221

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

8. 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

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

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

11. Specialist Thank you for the referral
Pain in shoulder last months
Limited ROM
No External rotation
Normal x rays
No need for scan
FROZEN SHOULDER

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

13. 123 Tests

14. 175
J Shoulder Elbow Surg Jul-Aug;18(4):529-34

15. …….. Perhaps this patient needs an MRI scan
60-69 =30% FTRCT
70-79 = 50% FTRCT
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

16. 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:

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

18. Tricky

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