Cadogan Angela, Mohammed Khalid D
Elmwood Orthopaedics, Christchurch, New Zealand. Email:
Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Dunedin, New Zealand.
J Prim Health Care. 2016 Mar;8(1):44-51. doi: 10.1071/HC15018.
BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.
背景与情境 肩周炎是一种病程漫长的疼痛性疾病。我们旨在根据初级保健中的现有指南，对被转诊至骨科专家进行评估的肩周炎患者的管理情况进行综述。问题评估 对所有被转诊至骨科专家进行评估并被确诊为肩周炎的患者的转诊情况和临床记录进行了审查。将新西兰一个地区初级卫生保健机构的诊断、检查和管理实践与指南推荐的管理方法进行了比较。结果 在为期13个月的研究期间，80例肩周炎患者被转诊至骨科进行评估，大多数来自全科医疗。在医疗转诊中，15例患者（19%）被确诊为肩周炎。大多数患者（99%）之前接受过影像学检查。7例患者（12%）接受了指南推荐的治疗。改进策略 对所有参与患者管理的临床医生进行教育很重要，以确保他们了解肩周炎漫长的自然病程，并让患者放心，其预后通常良好。健康路径现在包含了更多关于肩周炎诊断、影像学检查和循证管理的信息。经验教训 在转诊至骨科进行复查的患者中，肩周炎可能未得到充分诊断。超声成像常用，可能会发现该年龄组隐匿的和不相关的病变。按照临床指南进行管理时，患者的临床和功能有显著改善，大多数患者报告称1年后与正常情况相比功能恢复了80%。关键词 粘连性关节囊炎；滑囊炎；注射；实践指南；初级卫生保健；超声
