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MSK Conditions: Assessing the Shoulder Joint

Dr Mike Smith MBBS MRCS(Eng) MRCGP - 3 May, 2018

We see a lot of musculoskeletal complaints in primary care. A lot of these are shoulders.

After being a GP for just a few months, and sick of diagnosing ‘Shoulder Sprain’, prescribing NSAIDS and saying to return if worse, I decided that I wanted to be better.

Better at giving a more specific diagnosis, better at knowing when to refer and when to investigate, and better at offering a treatment plan that’s actually likely to improve my patients condition.

And so I asked a good physio friend of mine whether she could make me better at assessing the shoulder joint. She’s an Extended Scope Physiotherapist, and was running MSK clinics at the local community hospital, on behalf of the local acute trust.

I explained that when anyone presented with shoulder pain, we only had 10 minutes to take a history, do an examination, diagnose and start treatment.

I don’t know”, she replied, “It’s going to be tricky

That’s what I thought”, I said, thinking of how I was going to learn more than 120 eponymous tests for the shoulder, never mind trying to perform them.

“I mean”, she continued with a smile, and “what are you going to do for the remaining 8 minutes?

What followed was probably the most educational hour of my life, and something that changed my practice forever.

I learnt who does and who doesn’t get frozen shoulder.

I learnt the spectrum of disease that affects the rotator cuff.

I learnt the limited value of a plain x-ray in the majority of shoulder complaints.

I also was told the real reason behind the silly amount of eponymous tests.

The ultimate test came on holiday in Ireland last Christmas with my mother, who had let everyone know in the car, in the hotel and on the ferry that she had a worsening shoulder problem, which was limiting her activities.

It all came to a head in a small Irish Pub, outside Killarney, County Kerry, where my mother was lamenting what the point was of having a son as a GP, if he was unable to sort her shoulder out.

After a 3 minute chat, and an examination not unlike the ‘Macarena’, I was able to give an accurate diagnosis and treatment plan for her, and am pleased to say she is back to playing bridge with her friends on the South Coast of England, without a mention of her shoulder.

Her GP (a semi-retired Irish chap who I know quite well) even sent me a text.

“Just to say your diagnosis and treatment was spot on. Your mum came to see me for a second opinion!”

Praise indeed.

10 years on, and after many sessions volunteering with Orthopaedic Surgeons, Rheumatologists and more usefully Physiotherapists, I now consider myself an expert in the subject matter.

I find myself prescribing, referring and investigating less (except when I need to of course.) I have shared my knowledge with thousands of GPs, Nurses and other staff, and I hope am making a difference to both mine and their patients.

Working with NB Medical, we have assembled the best team of MSK experts we could find, and put together a programme of case studies, videos and punchy talks to cover, literally from head to toe, all the common MSK conditions you a likely to encounter.

Come and join us.

The weather will be better then!

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