A survey of general practitioners' assessment and management of shoulder pain: training and practice

Abstract

Introduction: Weaknesses in training of general practitioners (GPs) in musculoskeletal care have been identified. Little is known about methods of training GPs in shoulder pain management or the assessments they use in clinical practice. The aim of this study was to assess the effect of training methods in shoulder pain management on GPs' clinical practice.

Methods: A validated, self-administered postal questionnaire on dealing with shoulder pain was sent to 1081 GPs.

Results: Response rate was 48% (n = 520). The majority (82%) identified training at postgraduate meetings, 17% had attended clinics and 11% attended musculoskeletal courses. Practitioners who had been trained at clinics (odds ratio [OR] 17.5) and musculoskeletal courses (OR 8.2) were likely to perform injections. Similarly, GPs' confidence in shoulder examination was related to their attendance at clinics (P = 0.019) and musculoskeletal courses (P < 0.001) but not postgraduate meetings. In their clinical examination, GPs found that assessing the active range of movement (ROM), passive ROM and painful arc were the most useful clinical findings and they found corticosteroid injection, NSAIDs and physiotherapy equally effective in treatment and each more effective than doing nothing.

Conclusions: General practitioners' confidence in assessment of shoulder pain and their likelihood of performing injections was increased by training either at a clinic or specific musculoskeletal course but not by simply attending postgraduate meetings. They found the most useful methods of assessment to be range of movement and painful arc, and considered injection, physiotherapy and NSAIDs as equally effective.

Keywords:

• PRIMARY CARE
• TRAINING
• SHOULDER PAIN
• CORTICOSTEROID INJECTION