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The Painful Shoulder

The painful shoulder is a common presentation. It is the third most common cause of musculoskeletal consultation in primary care, and approximately 1% of adults consult a general practitioner with new shoulder pain annually (Research from Oxford, BMJ. 2005 Nov 12; 331(7525): 1124–1128).

This can be associated with an injury or may occur spontaneously. The diagnosis is based on a good history and examination. Shoulder examination can be challenging for clinicians who do not normally deal with this joint. I use X-rays, ultrasound scans, MRIs, CT scans to confirm the diagnosis. I work closely with Musculoskeletal radiologists and regional MDT teams so that my patients have the best evidence-based treatment.

Adhesive capsulitis or frozen shoulder is one of many conditions that can cause pain in the shoulder. Various other condition which can cause shoulder pain are shoulder impingement, bursitis, tendonitis, instability or dislocations, rotator cuff disease or tendon tear, arthritis, calcific tendonitis etc.

It is important to take a full history. Several factors such as the patient’s age, handedness, occupation, hobbies, the onset and timing of pain, associated stiffness and a history of injury all help to provide a diagnosis but can also determine the course of treatment. It is important to remember that an injury to the shoulder may lead to fracture, tendon tear or dislocation. If a shoulder remains very painful or lacks movement after an injury, despite adequate rest and a normal X-ray, then tendon or ligament injury is suspected. In these situations, it is important to seek expert advice.

Shoulder arthroscopy (key-hole surgery) has revolutionised the treatment of shoulder problems in the last 3 decades. Improvements in imaging technology helps me to diagnose problems in the majority of my patients without any surgery. When surgery is needed mostly it can be done arthroscopically which enables a quicker recovery. I have developed the practice of wide-awake hand, elbow and wide-awake shoulder surgery which means if the patient is keen not to have a general anaesthetic or is at high risk then most of procedures can still be performed with the patient fully awake or under gentle sedation.