Shoulders can be a tricky diagnostic area for GPs. Upper limb orthopaedic surgeon Dr Taro Okamoto knows this.
About 50% of the patients he sees present with shoulder complaints. So why are they so tricky, and what would Dr Okamoto tell a room full of GPs?
Dr Okamoto spoke to Medical Forum ahead of a his talk on niggling shoulders at Medical Forum Live on May 9.
“The diagnostic area starts to become tricky because with a complex joint like the shoulder, if you send a patient off for a scan, it’s often not just one positive finding that comes back,” he said
“These patients are often mid to elderly age and if you scan their normal shoulder, which they’re not complaining of, often lots of things are picked up as well.”
Like any specialist, there were certain conditions he often sees that might not need to be referred to him, but also there were some conditions that often get to him later than would have been ideal.
Dr Okamoto said the two pathologies he sees more than necessary were often treated quite well with a cortisone injection or physiotherapy.
Those were frozen shoulder and minor rotator cuff tears where patients have minor impingement problems but still have full range of motion. Dr Okamoto said while GPs could do cortisone injections for these patients, they also have the option of referring them to a radiologist for this to be done.
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He said patients with large rotator cuff tears were those who he too often saw in his rooms later than he would like.
“With the rotator cuff, when there’s a full thickness tear, it can retract because it’s a muscle and a tendon unit that’s under tension,” Dr Okamoto said.
“That can tear and then come off and because it’s under tension it can spring back like a rubber band. Over time, if it’s left too long, the muscle can atrophy and it might get to the point where we can no longer stretch the tendon back onto the bone where it came from.
“Or the muscle might have shrivelled up so much that even if we are able to repair it, the muscle doesn’t work anymore.
“That’s something that will change the outcome or the possibilities for surgery, so that’s something that we would like to see sooner rather than later.”
He said there were indicators that GPs could use to identify such situations. Referring for an MRI or an ultrasound would pick up on a large tear that needs to be referred to an orthopaedic surgeon.
“If there’s any form of full thickness tearing, that’s an indication to either proceed to an MRI and if they’ve already got that then get a specialist to review.”
Dr Okamoto will be speaking at Medical Forum Live, a clinical education event taking place on May 9 where attendees can earn up to 22 hours of CPD.
His talk, The Niggling Shoulder, will be one of the presentations taking place. The day will cover clinical education on common, acute and chronic presentations to general practice. Connect with colleagues from across WA and complete almost 50% of your yearly CPD requirements.
REGISTER TO ATTEND – SPACES ARE LIMITED
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