Re: Assessment of shoulder pain for non-specialists
This article, if it is supposed to be a guide for general practitioners, is just about useless. It is in the same category as the review of frozen shoulder published in the BMJ last year (1). Serious conditions (joint infection, dislocation, fracture, cancer, etc.) are pointed out, but how often would these be seen in general practice?
The ‘targeted shoulder examination’ with its emphasis on palpation is too vague to be of any help, and the four (three eponymous) ‘Simple tests to screen for common [shoulder] conditions in primary care’ are grossly inadequate as a means of reaching a diagnosis. The term ‘subacromial pain syndrome’ is meaningless and reminiscent of the long-discredited ‘peri-arthritis’.
As for ‘a pragmatic approach’ to treatment, the suggestions given are patronizing or almost laughable: ‘Consider offering the patient an information leaflet’, ‘Consider offering simple analgesia’, ‘Encourage as normal activity as the patient is able.’
Mr Aldridge says in the video: ‘Each specialist clinician often has their own idiosyncratic way of examining the shoulder.’ This is the problem!
How about learning to perform a standardized systematic clinical examination that will enable an accurate tissue diagnosis to be made in most cases? (2) (3)
Rapid Response:
Re: Assessment of shoulder pain for non-specialists
This article, if it is supposed to be a guide for general practitioners, is just about useless. It is in the same category as the review of frozen shoulder published in the BMJ last year (1). Serious conditions (joint infection, dislocation, fracture, cancer, etc.) are pointed out, but how often would these be seen in general practice?
The ‘targeted shoulder examination’ with its emphasis on palpation is too vague to be of any help, and the four (three eponymous) ‘Simple tests to screen for common [shoulder] conditions in primary care’ are grossly inadequate as a means of reaching a diagnosis. The term ‘subacromial pain syndrome’ is meaningless and reminiscent of the long-discredited ‘peri-arthritis’.
As for ‘a pragmatic approach’ to treatment, the suggestions given are patronizing or almost laughable: ‘Consider offering the patient an information leaflet’, ‘Consider offering simple analgesia’, ‘Encourage as normal activity as the patient is able.’
Mr Aldridge says in the video: ‘Each specialist clinician often has their own idiosyncratic way of examining the shoulder.’ This is the problem!
How about learning to perform a standardized systematic clinical examination that will enable an accurate tissue diagnosis to be made in most cases? (2) (3)
symonds@tokyobritishclinic.com
1. BMJ 2016;354:i4162
2. Cyriax J, Textbook of Orthopaedic Medicine, Vol I. Diagnosis of soft tissue lesions. London: Baillière Tindall,1982: 127–158.
3. Ombregt L, Bisschop P, et al. A System of Orthopaedic Medicine. Churchill Livingstone, 2003: 291 – 303.
Competing interests: No competing interests