Shoulder pain, a prevalent issue in primary care, has led experts to question the conventional approach to its management. A recent review by Monash University challenges the routine use of scans, advocating for a more patient-centric and timely self-management strategy.
The review highlights that most shoulder problems can be effectively addressed through simple supportive care, education, and time. Routine scans, such as X-rays, ultrasounds, or MRIs, are often unnecessary and may not provide valuable insights into the patient's pain.
Lead author Dr. Romi Haas emphasizes the importance of a thorough history and clinical examination to rule out serious conditions like broken bones or infections. She argues that the traditional approach of seeking structural flaws through scans may cause unnecessary worry and overdiagnosis.
"Abnormalities seen on scans are common in people without shoulder pain and are often harmless signs of aging," Dr. Haas explains. This perspective shifts the focus from finding a structural cause to understanding the patient's symptoms and providing appropriate support.
The review's findings suggest that early scans, such as MRIs, do not improve long-term recovery. Instead, GPs can reassure patients that self-management, targeted advice, and time are often the safest and most effective path to healing.
Associate Professor Michael Tam, co-Chair of the RACGP's First do no harm guide, supports this approach. He notes that most shoulder pain is benign and self-limiting, and the treatment for common conditions is similar across the board.
"The key is education and reassurance, along with symptom management and activity modification," he says.
Dr. Haas further emphasizes the importance of GPs' active role in reducing overuse of tests and interventions. She highlights that reducing overuse does not mean doing nothing; rather, it involves ruling out serious pathologies, monitoring progress, and providing ongoing support and pain relief as needed.
In addition, the review challenges the effectiveness of corticosteroid injections and subacromial decompression surgery for shoulder pain management. Evidence suggests that image-guided injections offer no additional benefit over using the patient's physical anatomy, and surgery provides no meaningful advantage over placebo or non-operative management.
"This reminds us that pain is not always caused by a structural issue that can be surgically fixed," Dr. Haas concludes.
In my opinion, this review highlights the need for a paradigm shift in shoulder pain management. By focusing on patient-centric care, GPs can provide effective support while avoiding unnecessary interventions and their potential harms. It's a fascinating insight into the complexities of medical practice and the importance of evidence-based decision-making.
