Artus Majid, van der Windt Danielle A, Afolabi Ebenezer K, Buchbinder Rachelle, Chesterton Linda S, Hall Alison, Roddy Edward, Foster Nadine E
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK.
Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.
BMJ Open. 2017 Jun 21;7(6):e015711. doi: 10.1136/bmjopen-2016-015711.
Studies in Canada, the USA and Australia suggested low confidence among general practitioners (GPs) in diagnosing and managing shoulder pain, with frequent use of investigations. There are no comparable studies in the UK; our objective was to describe the diagnosis and management of shoulder pain by GPs in the UK.
A national survey of a random sample of 5000 UK GPs collected data on shoulder pain diagnosis and management using two clinical vignettes that described primary care presentations with rotator cuff tendinopathy (RCT) and adhesive capsulitis (AdhC).
Seven hundred and fourteen (14.7%) responses were received. 56% and 83% of GPs were confident in their diagnosis of RCT and AdhC, respectively, and a wide range of investigations and management options were reported. For the RCT presentation, plain radiographs of the shoulder were most common (60%), followed by blood tests (42%) and ultrasound scans (USS) (38%). 19% of those who recommended a radiograph and 76% of those who recommended a USS did so 'to confirm the diagnosis'. For the AdhC presentation, the most common investigations were blood tests (60%), plain shoulder radiographs (58%) and USS (31%). More than two-thirds of those recommending a USS did so 'to confirm the diagnosis'. The most commonly recommended treatment for both presentations was physiotherapy (RCT 77%, AdhC 71%) followed by non-steroidal anti-inflammatory drugs (RCT 58%, AdhC 74%). 17% opted to refer the RCT to secondary care (most often musculoskeletal interface service), compared with 31% for the AdhC.
This survey of GPs in the UK highlights reliance on radiographs and blood tests in the management of common shoulder pain presentations. GPs report referring more than 7 out of 10 patients with RCT and AdhC to physiotherapists. These findings need to be viewed in the context of low response to the survey and, therefore, potential non-response bias.
加拿大、美国和澳大利亚的研究表明，全科医生（GP）在诊断和处理肩部疼痛方面信心不足，且经常进行检查。英国尚无类似研究；我们的目的是描述英国全科医生对肩部疼痛的诊断和处理情况。
对5000名英国全科医生进行随机抽样的全国性调查，使用两个临床病例描述了肩袖肌腱病（RCT）和粘连性囊炎（AdhC）的初级保健表现，收集有关肩部疼痛诊断和处理的数据。
共收到714份（14.7%）回复。分别有56%和83%的全科医生对其RCT和AdhC诊断有信心，报告了广泛的检查和处理选项。对于RCT病例，肩部X线平片最常见（60%），其次是血液检查（42%）和超声扫描（USS）（38%）。推荐进行X线检查的人中有19%以及推荐进行USS检查的人中有76%这样做是“为了确诊”。对于AdhC病例，最常见的检查是血液检查（60%）、肩部X线平片（58%）和USS（31%）。推荐进行USS检查的人中有超过三分之二这样做是“为了确诊”。两种病例最常推荐的治疗方法都是物理治疗（RCT为77%，AdhC为71%），其次是非甾体类抗炎药（RCT为58%，AdhC为74%）。17%的人选择将RCT患者转诊至二级医疗（最常见的是肌肉骨骼界面服务），而AdhC患者的这一比例为31%。
这项对英国全科医生的调查突出了在处理常见肩部疼痛病例时对X线平片和血液检查的依赖。全科医生报告称，每10名RCT和AdhC患者中，有超过7名将被转诊给物理治疗师。这些发现需要结合调查的低回复率以及因此可能存在的无应答偏倚来审视。
