A talk for GPs and physiotherapists
Dr Kenneth Cutbush presented at the Brisbane Private Hospital Education Day, held on 21 August 2021, to an audience of general practitioners and physiotherapists.
Why hospitals run education days
An education day is a programme of short talks by specialists, put on for the general practitioners, physiotherapists and other clinicians who refer patients to the hospital. Sessions usually carry continuing professional development points, which clinicians are required to accumulate each year, but the practical purpose is the exchange itself.
A general practitioner sees the whole range of shoulder presentations and has to sort them with a short consultation and limited investigation. A specialist sees a filtered selection of them, usually after imaging. Putting the two in the same room lets each describe what the other needs to know: what a specialist would like included in a referral and at what stage, and equally what a referrer is actually working with when the decision has to be made. The question sessions after these talks tend to be the most useful part.
The conditions covered
The talk worked through the conditions that account for most shoulder presentations in general practice:
- Bursitis, tendinitis and impingement.
- Rotator cuff tears.
- Frozen shoulder.
- Shoulder arthritis.
- Shoulder instability.
Briefly: bursitis and impingement involve irritation of the tissues in the narrow space above the rotator cuff, and typically hurt 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, producing stiffness in every direction that usually develops and then settles over a long period. Shoulder arthritis is wear of the cartilage on the joint surfaces. Instability is the joint failing to stay in place after the labrum, capsule or bone of the socket rim has been damaged.
Most of these are managed without surgery, and the practical value of a session like this lies in distinguishing the presentations that will settle with time and physiotherapy from the smaller number that warrant imaging or referral. Individual results vary.
Related information
- The shoulder injuries page.
- Our post on the 2021 Brisbane Private Hospital Education Day.
- The rehabilitation page explains the recovery process.
- The consultation page explains the referral process.