A talk for general practitioners
Dr Kenneth Cutbush spoke at the St Andrew's Hospital General Practice Day on common shoulder conditions.
General practitioners see the great majority of shoulder problems, and most of those never need a surgeon. Talks of this kind are directed at the practical questions: which presentations warrant imaging, which settle with physiotherapy, and which are worth referring on.
The common shoulder conditions
A small number of diagnoses account for most shoulder presentations in general practice.
- Rotator cuff problems, ranging from tendon irritation and impingement through to partial and full thickness tears of the tendons that move and steady the shoulder.
- Frozen shoulder, in which the capsule of the joint becomes inflamed and then contracts, producing pain and a marked loss of movement in every direction.
- Shoulder arthritis, where the joint surfaces themselves have worn.
- Instability, where the joint dislocates or partly slips out of position.
- Acromioclavicular joint problems, felt as pain localised to the top of the shoulder.
- Calcific tendonitis and subacromial bursitis, either of which can cause severe pain over a short period.
Telling them apart rests largely on the history and the examination. Where the pain sits, which movements provoke it, whether it wakes the patient at night, and whether movement is lost actively, passively or both, all point in different directions. Individual results vary, and treatment ranges from physiotherapy and injection through to surgery depending on the diagnosis and on the patient.
Why hospitals hold general practice days
A general practitioner is the first point of contact for nearly every shoulder problem and manages most of them without a surgeon ever being involved. The questions that matter in that setting are practical ones: which presentations warrant an ultrasound or an MRI and which do not, how long to persist with physiotherapy before reconsidering, which findings suggest a tear unlikely to settle on its own, and which cases are worth referring promptly rather than after several months.
Education days hosted by hospitals also serve a simpler purpose. Referral works better when the people at either end of it have met, because a referral letter conveys very little compared with a conversation.
Related information
Our shoulder injuries page covers the common conditions, and the consultation page explains the referral process. See also our pages on rotator cuff tear, frozen shoulder, shoulder impingement, subacromial bursitis, calcific tendonitis and AC joint arthrosis.