Shoulder pain in primary care: frozen shoulder
Angela Cadogan 1 3 , Khalid D. Mohammed 21 Elmwood Orthopaedics, Christchurch, New Zealand
2 Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Dunedin, New Zealand
3 Correspondence to: Angela Cadogan Elmwood Orthopaedics, Specialists @ Eleven, 11 Caledonian Road, St Albans, Christchurch, New Zealand. Email: acadogan@vodafone.co.nz
Journal of Primary Health Care 8(1) 44-51 https://doi.org/10.1071/HC15018
Published: 31 March 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
BACKGROUND AND CONTEXT: Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care.
ASSESSMENT OF PROBLEM: Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management.
RESULTS: Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment.
STRATEGIES FOR IMPROVEMENT: Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder.
LESSONS: Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year.
KEYWORDS: Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound
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