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. 2021 Sep 25;38(5):582-588.
doi: 10.1093/fampra/cmab022.

The incidence and management of shoulder complaints in general practice: a retrospective cohort study

Pieter F van Doorn  1 , Evelien I T de Schepper  1 , Rianne M Rozendaal  1 , Ramon P G Ottenheijm  2 , Johan van der Lei  3 , Patrick J Bindels  1 , Dieuwke Schiphof  1
Affiliations

The incidence and management of shoulder complaints in general practice: a retrospective cohort study

Pieter F van Doorn et al. Fam Pract. .

Abstract

Background: Shoulder pain is the third most common musculoskeletal complaint in primary care. The international guidelines for general practitioners (GPs) recommend a stepwise treatment of shoulder pain. Little is known about the actual distribution of these treatments in current practice.

Objective: To gain insight in the incidence and current management of shoulder complaints in Dutch general practice.

Methods: A retrospective cohort study was conducted using a health care database containing the full electronic medical records of approximately 200 000 patients in Dutch general practice. A search algorithm was constructed to identify incident cases of shoulder complaints from January 2012 to December 2017. Data on the management of shoulder complaints were manually validated in a random sample of 1000 cases.

Results: The overall incidence of shoulder complaints was 30.3 (95% confidence interval 29.9-30.7) per 1000 person-years. More than half of the patients (58.6%) consulted their GP only once, 44.4% two times or more and 19.7% three times or more. For most patients (58.1%), the GP applied a wait-and-see policy or prescription of oral medication in the first consultation. However, no less than 42.9% of the patients were referred or received an injection already in the first consultation.

Conclusions: There is a wide variety of treatments for shoulder complaints applied by the GP. Some patients are referred or received an injection already in the first consultation. The stepwise approach recommended by the guideline, might not always be applicable due to the diversity of patient- and shoulder characteristics presented in general practice.

Keywords: Corticosteroid injection; general practice; incidence; physiotherapy; primary care; shoulder pain.

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Figures

Figure 1.
Figure 1.
Sex- and age-specific mean incidence rates of shoulder pain (2012–17).
Figure 2.
Figure 2.
Management of shoulder pain per consultation (2012–17). Note. Patients could be treated according to more than one policy; consequently, the total count of applied management policies may exceed the total number of patients at a given consultation. Percentages are based on number of patients at the first consultation.
Figure 3.
Figure 3.
Hierarchical visualization of the management of shoulder pain per consultation (2012–17). Note. The inner circle represents the policy in the first consultation (N = 916 patients). The second circle represents the policy in the second consultation (N = 379) and the third circle represents the policy in the third consultation (N = 180). Percentages are based on the management in the first consultation. Patients could be treated according to more than one policy; consequently, the total percentage may exceed 100%.
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