THE FREQUENCY OF RESTRICTED RANGE OF MOVEMENT IN INDIVIDUALS WITH SELF-REPORTED SHOULDER PAIN - RESULTS FROM A POPULATION-BASED SURVEY

Prevalence studies suggest that shoulder pain is very common (7-20%) i n the adult population, though little is known about the severity and impact of such pain. Disability results, in part, from the restriction of movement and we therefore determined the frequency of restricted s houlder movement in individuals in a general population sample reporti ng shoulder pain and associated disability. In all, 232 individuals we re interviewed about shoulder pain and related disability, and their r ange of shoulder movement in the following planes was measured: elevat ion, forward flexion, backward flexion, external rotation and internal rotation, together with the minimum difference achieved between the t ip of a thumb and the spinous process of C7. In total, 48 (21%) subjec ts reported current pain and disability in one or both shoulders. Usin g receiver operating characteristic (ROC) analysis, cut-offs for restr icted movements were selected at the point of maximal discrimination b etween painful and pain-free shoulders. There was considerable overlap in the distribution of range of movement, at all six sites, between t hese two groups. The highest positive predictive value for pain was ob served in restriction of the thumb to cervical spine movement (53%), b ut this also had the lowest negative predictive value. By contrast, th e highest negative predictive value was observed for restriction of ex ternal rotation (96%). Restriction in any plane was observed in 77% of those individuals with pain, but was also present in half of those wi thout pain. In summary, most people with self-reported shoulder pain i n the community do not have widespread restriction of movement. Reduct ion in external rotation was the most discriminatory, but it is necess ary to examine movement in multiple planes to assess the true burden o f shoulder pain in the community.