Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series)

Abstract

Shoulder injuries are a commonly presenting complaint to the ED. In the absence of an obvious deformity, they can be difficult to assess and definitively diagnose because of the multiple structures that cause shoulder pain, the acuity and severity of pain and the lack of range of motion in the ED setting. The quality of ED care provided to patients with musculoskeletal shoulder pain is crucial to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common shoulder injuries and conditions in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines published in English-language in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were considered for inclusion. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence. The search revealed 1902 articles, of which 73 were included in the review (n = 12 primary articles, n = 49 systematic reviews and n = 12 guidelines). This rapid review provides clinicians who manage shoulder dislocations, fractures and soft tissue injuries in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is strong evidence to support taking a thorough history and physical examination, with cautious use of special tests because of their poor diagnostic accuracy. Key points regarding the diagnosis and management of these injuries are provided.

Evaluating musculoskeletal urgent care center triage and transfer of emergency conditions for emergency surgical assessment and intervention

“…This replicates the findings of Hsiang et al [6] As triage has been found to increase ED referral likelihood, a short set of triage questions should be implemented by MUCCs to ensure that patients seek care at the appropriate care setting. Strudwick et al [13][14][15][16][17][18] published a series of papers recommending history questions and red flags for a variety of orthopedic conditions, however no simple set of triage questions has been recommended for use in the MUCC setting. While we do not expect a receptionist to perform a detailed history over the phone, we recommend that a short set of triage questions be utilized to prevent delays in care caused by directing patients to a MUCC instead of the ED.…”

CORR Synthesis: What Triage Recommendations Are Available for Emergent or Urgent Musculoskeletal Conditions?

“…One group from Australia provided recommendations for assessment, imaging, treatment, referrals, and followup for common orthopaedic conditions by assembling guidelines from systematic reviews. However, these reviews were not performed in urgent care or emergency settings [26][27][28][29][30][31]. These reviews covered foot and ankle injuries, low back pain, hand and wrist injuries, knee injuries, neck injuries, and shoulder injuries.…”