SHOULDER DISORDERS IN GENERAL-PRACTICE - INCIDENCE, PATIENT CHARACTERISTICS, AND MANAGEMENT

Objectives-To study the incidence and management of intrinsic shoulder disorders in Dutch general practice, and to evaluate which patient ch aracteristics are associated with specific diagnostic categories. Meth ods-In 11 general practices (35 150 patients) all consultations should er complaints were registered during a period of one year. Patients wi th an intrinsic shoulder disorder who had not consulted their general practitioner for the complaint during the preceding year (incident cas es) were asked to participate in an observational study. Participants completed a questionnaire regarding the nature and severity of their c omplaints. The general practitioners recorded data on diagnosis and th erapy. Results-The cumulative incidence of shoulder complaints in gene ral practice was estimated to be 11.2/1000 patients/year (95% confiden ce limits 10.1 to 12.3). Rotator cuff tendinitis was the most frequent ly recorded disorder (29%). There were 349 incident cases enrolled in the observational study. Patient characteristics showed small variatio ns between different diagnostic categories. Age, duration of symptoms, precipitating cause and restriction of movement seemed to be discrimi nating factors. Twenty two percent of all participants received inject ions during the first consultation; most (85%) were diagnosed as havin g bursitis. The majority of patients with tendinitis (53%) were referr ed for physiotherapy. Conclusion-With respect to diagnosis and treatme nt, the practitioners generally appeared to follow the guidelines issu ed by the Dutch College of General Practitioners. Although the patient characteristics of specific disorders showed some with the clinical p ictures in the literature, further research is required to demonstrate whether the proposed syndromes indeed constitute separate disorders w ith a different underlying pathology, requiring different treatment st rategies.