title: General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: an Australian national survey.
abstract: OBJECTIVE
  To determine whether current care for common shoulder problems in Australian general practice is in keeping with rheumatologist expectations and the best available evidence.
  
  
  METHODS
  We performed a mailed survey of a random sample of 3500 Australian GPs and an online survey of all 270 rheumatologists in Australia in June 2009. Each survey included four vignettes (first presentation of shoulder pain due to rotator cuff tendinopathy, acute rotator cuff tear in a 45 year-old labourer and early and later presentation of adhesive capsulitis). For each vignette, GPs were asked to indicate their management, rheumatologists were asked to indicate appropriate primary care, and we determined best available evidence from relevant Cochrane and other systematic reviews and published guidelines.
  
  
  RESULTS
  Data were available for at least one vignette for 614/3500 (17.5%) GPs and 64 (23.8%) rheumatologists. For first presentation of rotator cuff tendinopathy, 69% and 82% of GPs and 50% and 56% rheumatologists would order a shoulder X-ray and ultrasound respectively (between group comparisons P = 0.004 and P<0001). Only 66% GPs and 60% rheumatologists would refer to an orthopaedic surgeon for the acute rotator cuff tear. For adhesive capsulitis, significantly more rheumatologists recommended treatments of known benefit (e.g. glucocorticoid injection (56% versus 14%, P<0.0001), short course of oral glucocorticoids (36% versus 6%, p<0.0001) and arthrographic distension of the glenohumeral joint (41% versus 19%, P<0.0001).
  
  
  CONCLUSIONS
  There is a mismatch between the stated management of common shoulder problems encountered in primary care by GPs, rheumatologist expectations of GP care and the available evidence.
authors.affiliation: Monash Department of Clinical Epidemiology, Cabrini Health, Monash University, Melbourne, Victoria, Australia. rachelle.buchbinder@monash.edu
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Margaret P
authors.initials: MP
authors.lastname: Staples
authors.forename: E Michael
authors.initials: EM
authors.lastname: Shanahan
authors.forename: Juliana F
authors.initials: JF
authors.lastname: Roos
mesh_terms: D001315:Australia; D002062:Bursitis / Q000188:drug therapy / Q000601:surgery; D003625:Data Collection; D058005:General Practitioners / Q000706:statistics & numerical data*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D012219:Rheumatology / Q000379:methods*; D017006:Rotator Cuff / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D020069:Shoulder Pain / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D005938:Glucocorticoids