THE 5 MINUTE SHOULDER APPROACH IN GENERAL PRACTITIONER CONSULTATION

Background & Aim Shoulder pathology and pain represents a prevalent issue in the general practitioner consult. The majority of this pathology is caused by peri-articular structures, which support and stabilise the articulation, or referred pain. The peri-articular structures include tendons (principally the rotators cuff), ligaments and bursas, that commonly are affected inflammation (acute or chronic) or rupture. Most of this pathology is managed by nonsurgical treatments. The purpose of this presentation is to make the general practitioner able to do a quick and systematic evaluation of the shoulder and manage its treatment. Method Presentation of a short and systematic evaluation algorithm of the shoulder pathology. Starting with a small revision of important aspect of anatomy in shoulder region and nociceptive structures. Systematic clinical evaluation with a focused anamnesis and objective exam. An overview of common causes of shoulder pain and functional disability, and its treatments. (Rotator cuff injury, Labral tear, Adhesive capsulitis, shoulder instability, glenohumeral osteoarthritis). A quick reference of the most common causes of referred shoulder pain (neural impingement at the level of the cervical spine, peripheral nerve entrapment, diaphragmatic irritation and myocardial ischemia) Results Capacitate the general practitioner to evaluate effectively shoulder complains, guiding the investigation and the treatment, making the consult more usefull for the patient well-being. Conclusions With a simple algorithm and a systematic evaluation of the shoulder the objective exam is sufficient to suspect the diagnosis and start the treatment effectively, using just 5 min of consult.