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Physio interest : The Painful shoulder

Cost to the UK 31% of people report experiencing pain at work at least once a week. Back pain= 67% Shoulder =37% Neck =37% Time taken off work for a MSK disorder = A cost to the UK of £7.4 billion a year. Physio interest : The Painful shoulder. When to refer?

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Physio interest : The Painful shoulder

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  1. Cost to the UK • 31% of people report experiencing pain at work at least once a week. • Back pain= 67% • Shoulder =37% • Neck =37% • Time taken off work for a MSK disorder = A cost to the UK of £7.4 billion a year. Physio interest : The Painful shoulder • When to refer? • If symptoms are mechanical in nature. • If mechanism of injury suggests that of soft tissue injury pathology ie trauma/repetitive strain. • If shoulder pain is effecting work and patient is at risk of sick leave. • When to refer on….. • If fracture or dislocation is suspected. • If 3/12 of conservative measures have been exhausted (in cases of SIS) (AAOS,2002). • Presence of red flags. • Common Conditions • Shoulder impingement (SIS) • Frozen shoulder (adhesive • capsulitis) • Shoulder instability • Trigger point referral • Disclocations • Post shoulder replacement • Acromioclavicular joint strain • Elevation of the 1st rib • Rotator cuff tear/dysfunction • Rule out neurogenic referral • Case Study • A 52 year gentleman attends physiotherapy complaining of a five month history of right shoulder pain. He is Right hand dominant. • Subjective findings • Pain at night particularly when lying on right side. • Difficulty reaching above shoulder head height. • Nil PMH of note. • Objective findings • Full range passive shoulder elevation. • Painful arc. 3 x positive impingement tests. • IR= hand to waist height. • ER=hand to ear. • Diagnosis: Shoulder Impingement • Aims of Physio • Reduce pain • Increase ROM • Improve shoulder dynamic stability • Treatments • In accordance with current evidence and NICE guidelines • Relative rest and acupuncture to reduce pain. • Restoration of ROM, strength and scapulohumeral rhythm. This is achieved through the use of manual therapy, exercises and posture re-education. • Conclusion • After a course of 4 sessions the man reported reduced pain, increased function a and improved sleep patterns. • References: • American Academy of Orthopeadic Surgeons(2002) Criteria for shoulder surgery, Rosemont(IL)American Academy ofOrthopeadicSurgeons. Available at www.guideline.gov • HanchardN, Cummins J and Jeffries C.(2004) Evidence based clinical guidelines for the diagnosis, assessment and physiotherapy management of shoulder impingement syndrome. Chartered Society of Physiotherapy, London. UK.

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