A morning with nurse practitioners
A morning in the clinic with Nurse Practitioners Liz Puze and Naomi O'Rourke, discussing shoulder care.
Why this matters in practice
Nurse practitioners are often the first clinicians a patient with shoulder pain sees, and they frequently manage the follow-up afterwards. That makes their understanding of what a given shoulder condition involves, and of what surgery can and cannot be expected to achieve, directly relevant to the care the patient receives.
It is valuable to collaborate and share knowledge with clinicians who care about patient care and about advancing it.
What a nurse practitioner does
A nurse practitioner is a registered nurse with additional postgraduate qualifications and an extended scope of practice, which in Australia allows them to assess and diagnose, order and interpret investigations, prescribe within their scope and refer on. They work across general practice, emergency departments, hospital wards and specialist clinics.
In musculoskeletal care that puts them at both ends of the pathway. They see patients at the point of first presentation, when the question is whether this shoulder needs imaging, a course of physiotherapy or a specialist opinion, and they see them again afterwards, when the question is whether recovery is following the expected course or something has changed. Both judgements rest on knowing what the underlying condition is actually doing.
The conditions that come up most
A small number of problems account for most shoulder presentations. Subacromial bursitis and impingement involve irritation of the tissues in the narrow space above the rotator cuff tendons, and usually cause pain on reaching overhead. A rotator cuff tear is one of those tendons pulling away from the bone, which affects strength as well as causing pain. Frozen shoulder is a thickening and tightening of the joint capsule, which produces progressive stiffness in all directions, often over many months. Shoulder arthritis is wear of the cartilage on the joint surfaces. Instability is the joint not staying reliably in place after the structures that hold it have been torn.
Most of these are managed without surgery, with physiotherapy, changes to activity and sometimes an injection, so a great deal of the practical value in a discussion like this one lies in telling them apart, and in recognising the smaller number of presentations that need imaging or a specialist opinion rather than more time. Individual results vary.
Related information
- The shoulder injuries page covers the ground discussed.
- The rehabilitation page explains the recovery process.
- The frozen shoulder and subacromial bursitis pages.
- The consultation page explains the referral process.