Treating shoulder complaints in general practice

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7109.680 (Published 13 September 1997) Cite this as: BMJ 1997;315:680

Authors' diagnostic system is unclear

  1. Gabriel Symonds, General practitionera
  1. a Tokyo British Clinic, 2-13-7 Ebisu-Nishi, Shibuya-ku, Tokyo 150, Japan
  2. b University of Durham, Durham
  3. c Avon Orthopaedic Centre, Southmead Hospital NHS Trust, Bristol BS10 5NB
  4. d Nieuwe Schoolweg 2A, 9756 BB Glimmen, Netherlands

    Editor—On what grounds do the authors of the study on treating shoulder complaints assert that “other diagnostic classifications, such as those by Cyriax…, were not suitable for diagnosing shoulder complaints in general practice.”?1 I have been using Cyriax's methods of diagnosing and treating shoulder disorders in general practice for over 20 years,2 with consistently good results3; they are quick and simple to use, being based on applied anatomy.

    In contrast, the diagnostic system of Jan C Winters and colleagues is unclear. Although the authors refer to another paper, in which “the three diagnostic groups have been described in detail,” this is of no help to the general reader because it is in Dutch. In the BMJ article the definition of shoulder complaints is too wide, encompassing pain felt anywhere from the neck and upper thorax to the wrist. Furthermore, no explanation is given of how the complicated procedures of “measuring the active and passive range of movement of the glenohumeral joint, cervical spine, and upper thoracic spine and palpating the muscle tendons on the head of the humerus, the acromioclavicular joint, and the upper ribs” resulted in patients being assigned to either a “synovial” or a “shoulder girdle” diagnostic group.

    The synovial group is said to have “consisted of patients with pain or limited movement…of the glenohumeral joint.” But what is the evidence for saying that “these complaints originated from disorders of the subacromial structures, the acromioclavicular joint, the glenohumeral …

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