TY - JOUR T1 - The painful shoulder: an update on assessment, treatment, and referral JF - British Journal of General Practice JO - Br J Gen Pract SP - e593 LP - e595 DO - 10.3399/bjgp14X681577 VL - 64 IS - 626 AU - Majid Artus AU - Tim A Holt AU - Jonathan Rees Y1 - 2014/09/01 UR - http://bjgp.org/content/64/626/e593.abstract N2 - Shoulder pain is the third most common musculoskeletal presentation in primary care after back and knee pain. Annually 1% of adults are likely to consult with new shoulder pain. The four most common underlying causes are rotator cuff disorders (85% of cases), glenohumeral disorders, acromioclavicular joint (ACJ) pathology, and referred neck pain. Although the vast majority of cases are treated satisfactorily, chronicity and recurrence are common, with estimates of 14% of patients still consulting 3 years on.Look for the following red flags that indicate the need for urgent investigations and/or referral to secondary care: acute presentation with a history of trauma (especially if pain restricts all passive and active movements); systemic symptoms such as fever, night sweats, weight loss, or new respiratory symptoms; abnormal joint shape; local mass or swelling; local erythema over a ‘hot’, tender joint; and severe restriction of movement.Enquire about the following: patient’s occupation; which may be relevant, especially if it involves repetitive arm movements and prolonged elevation;the onset of pain, its nature, duration, aggravating and relieving factors;whether the pain is constant, suggesting active joint inflammation;pain in other joints, suggesting the possibility of osteoarthritis or a systemic inflammatory condition such as rheumatoid arthritis; andhistory of malignancy such as lung or breast cancer.The focus should be on the four most common problems. Appendix 1 will help guide diagnosis, treatment, and referral decisions. None of the many specific clinical … ER -