The Painful Shoulder: Can Consultants Agree?

Abstract

As a two-phase exercise in inter-district audit, with the emphasis on critical evaluation of routine clinical practice, three rheumatologists each examined the same 44 patients with shoulder pain, and recorded their diagnosis and the investigations and treatment they would carry out. In the first phase, 26 patients were seen by each rheumatologist separately; there was complete diagnostic agreement in only 46%, with wide variation in the frequency of requests for standard investigations, but all three rheumatologists recommended steroid injections for most patients. In the second phase, all three rheumatologists examined a further 18 patients together, discussed the symptoms and signs, and recorded their diagnoses separately. There was complete agreement in 78%. The presence of more than one lesion, and differences in the interpretation of certain physical signs, partly explain the lack of agreement in Phase 1. Treatment of specific shoulder lesions is highly concordant, with injection the major treatment modality, followed by physiotherapy. Perhaps the different diagnoses reached, and the fact that treatment might therefore be administered for the wrong diagnosis, may explain some treatment failures. Also, recruitment of patients for studies of the treatment of shoulder lesions requires care to avoid selection of a heterogeneous group.

Pattern and Physiotherapy Management of Shoulder Pain A 5-Year Retrospective Audit of a Nigerian Tertiary Hospital

“…Various musculoskeletal disorders and injury were implicated as the possible causes of shoulder pain among the patients. Furthermore, difficulties has also been reported in arriving at specific diagnosis of shoulder conditions in patients since they often present similarly with regards to pattern of impairments with pain as the major symptom in many cases of shoulder dysfunctions [28,40,41]. In the present study no specific ICD coding was employed in diagnosis or in the categorization of the patients SP.…”

Shoulder disorders and occupation

“…Although many of the clinical diagnostic criteria for these specific shoulder disorders have been widely published and taught, perhaps because of the complex anatomical and functional structure, there is evidence to suggest that these patho-anatomical classification systems do not generally perform reliably in practice [23][24][25][26][27]. Their validity, at least in population and workplace studies, has also been questioned.…”

Clinical and MRI findings after high dosage medical exercise therapy in patients with long lasting subacromial pain syndrome: A case series on six patients

“…When the pain is caused by structures within the shoulder joint, there is a very low correlation between structural changes in soft tissues in the shoulder and the pain experience (Needell et al, 1996;Khan et al, 1998). Adding to the problem of making a true and correct tissue-at-fault diagnosis, health professionals generally find it difficult to agree on a common diagnosis and treatment for patients who have a painful shoulder (Bamji et al, 1996).…”