Why shoulders are tricky Spire - BRidge

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Why shoulders are trickySpire - BRidge

• Mr Lee Van Rensburg
• Mr Niel Kang
• March 2014

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(No Transcript)
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www.cambridgeses.co.uk
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www.cambridgeorthopaedics.com
office_at_cambridgemedicalpractice.co.uk
Rheumatology 200645215221
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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 200645215221
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Rheumatology 200645215221
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Referral

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

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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

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Referral

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

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Patient

• Impingement
• Tendonitis
• Problem biceps tendon SLAP tear
• Rotator cuff tear
• Special scan
• Getting worse
• Cant sleep
• Chew arm off

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Specialist

• Thank you for the referral
• Pain in shoulder last 4 - 6 months
• Limited ROM
• No External rotation
• Normal x rays
• No need for scan
• FROZEN SHOULDER

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VOL. 85-B, No. 6, AUGUST 2003
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123 Tests
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175
J Shoulder Elbow Surg. 2009 Jul-Aug18(4)529-34
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• .. 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
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• 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 200514233-237
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Arthroscopy Vol 26, No 3 (March), 2010 pp
393-403
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Tricky
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Shoulder pain

• Common
• Most get better on own
• Time
• Analgesia - NSAID
• If not better by 3 months refer?

BMJ. 2005 Nov 12331(7525)1124-8