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The prevalence of shoulder complaints in the UK is estimated to be 14%, with 1-2% of adults over 45 consulting their general practitioner annually with a new problem. Shoulder arthritis is the cause of pain in 2-5% of this group. (ref: BESS/BOA care pathways)
Community based treatments including analgesia, landmark guided injection and physiotherapy are the mainstay of treatment for most shoulder conditions.
Adults in primary care with glenohumeral osteoarthritis
Patients without glenohumeral osteoarthritis
Based on history and examination (see algorithm). The salient feature of glenohumeral joint stiffness is limitation of external rotation with the arm at the side. Other usual features of osteoarthritis (as with any joint) are pain, stiffness, crepitus. Incidence rises with age but should be considered as a possibility from 45 upwards.
The following interventions are suitable for administration in primary care (either by GP or physiotherapist):
Most patients will respond poorly to conservative treatment. Physical therapy may be of value in early arthritis (there is evidence for this in knee arthritis but not shoulder); pain relief from steroid injection typically lasts only 3-6 weeks.
Patients with Glenohumeral osteoarthritis, in whom severe and debilitating pain and/or functional limitation have persisted for more than 4 months despite the interventions listed above, can be considered for referral to secondary care.
This guideline has been signed off by South Devon and Torbay CCG.
Publication date: December 2017