title: Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups.
abstract: Arm, neck and/or shoulder complaints are common in western societies. In the Netherlands, general practice guidelines are issued on shoulder pain and epicondylitis only. Little is known about actual management of the total range of diagnoses. The objectives of the study are: to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation. To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups. In a prospective cohort study in general practice. We recruited 682 eligible patients. Data on diagnosis, management, patient- and complaint-characteristics were collected. Co-occurrence of treatment options was presented in scaled rectangles. After 6 months, additional diagnostic tests had been performed in 18% of the patients, mainly radiographic examination (14%). Further, 49% had been referred for physiotherapy and 12% to the medical specialist. Patients with specific diagnoses were more frequently referred for specialist treatment, and patients with non-specific diagnoses for physiotherapy. Corticosteroid injections (17%) were mainly applied specific diagnoses (e.g. impingement syndrome, frozen shoulder, carpal tunnel and M. Quervain). Frequencies of prescribed medication (51%) did not differ between specific and non-specific diagnoses. In 19% of the patients no referral, prescribed analgesics or injection was applied. Braces (4%) were mainly prescribed in epicondylitis. Overall, management most frequently consisted of prescribed analgesics and referral for physiotherapy. Specific and non-specific diagnostic subgroups differed in the frequency corticosteroid injections were applied, and referrals to physiotherapy and to a medical specialist.
authors.affiliation: Department of General Practice, Erasmus MC, Room Wk121, PO Box 2040, 3000 CA Rotterdam, The Netherlands. a.feleus@erasmusmc.nl
authors.forename: Anita
authors.initials: A
authors.lastname: Feleus
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: Harald S
authors.initials: HS
authors.lastname: Miedema
authors.forename: Jan A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D001134:Arm Injuries / Q000175:diagnosis* / Q000628:therapy*; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000628:therapy; D015331:Cohort Studies; D003348:Cortisone / Q000008:administration & dosage / Q000627:therapeutic use; D005194:Family Practice; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis* / Q000628:therapy*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012017:Referral and Consultation; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis / Q000628:therapy; D020069:Shoulder Pain / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000700:Analgesics; D003348:Cortisone