The lecture
Dr Cutbush lectured to the School of Medicine Year 1 MD course on "Common & Serious Shoulder Disorders" in July 2016.
The distinction in the title is the useful part for students at that stage: most shoulder problems are common and settle, and the skill being taught is recognising the small number that are serious and need acting on promptly.
The common shoulder disorders
Most shoulder problems seen in general practice fall into a small number of groups:
- Rotator cuff problems, ranging from irritation of the tendons to partial and full thickness tears of the tendons that move and stabilise the shoulder.
- Impingement and subacromial bursitis, where tissue is pinched beneath the bony arch at the top of the shoulder.
- Frozen shoulder, in which the lining of the joint becomes inflamed and contracted, causing pain and progressive loss of movement.
- Shoulder arthritis, where the cartilage surfaces of the joint wear.
- Instability, where the joint dislocates or repeatedly slips out of position, usually in younger patients.
- Acromioclavicular joint problems, at the junction between the collarbone and the shoulder blade.
- Calcific tendonitis, where calcium is deposited within a tendon.
Many of these are managed without surgery, with physiotherapy, a change in activity or time. Individual results vary.
The serious ones
The smaller group that needs prompt attention includes fractures and dislocations, infection in the joint, and nerve injuries such as damage to the brachial plexus. It also includes shoulder pain that is in fact coming from somewhere else, including the neck, the chest or the abdomen. Pain referred to the shoulder from the heart or the diaphragm is the classic example, and it is the reason a painful shoulder is never assessed in isolation from the rest of the patient.
Why teaching first year students matters
Students at this stage are not learning to treat shoulders. They are learning a pattern of thinking: take the history, examine properly, and work out whether what is in front of them belongs in the common group or the serious one. Most of them will become general practitioners or physicians rather than surgeons, and that sorting decision is the part of the lecture they will use for the rest of their careers.
Related information
See our shoulder injuries page, and our post on lecturing medical students at the University of Queensland. See also our pages on rotator cuff tear, frozen shoulder, shoulder impingement, subacromial bursitis, calcific tendonitis, shoulder arthritis and shoulder instability.