Shoulder pain: when to do something about it
Shoulder pain is one of the most common and debilitating joint problems, especially as we get older. As GPs, more than a quarter of our consultations are musculoskeletal problems, so we’re used to managing this. But we’re always on alert for the rare occasion that something is seriously wrong, and we need to get a patient the right help with speed.
Along with GPs, many surgeries offer a first-contact physiotherapy service to triage your problem and manage it – you may even be able to refer yourself without speaking to your GP. It’s a great service but you may have a few weeks’ wait.
In this article we’ll go through some of the more serious symptoms relating to shoulder pain, and when you should be urgently seeking help from your GP (or Emergency Department in some circumstances), rather than waiting for a routine appointment or physio assessment.
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What are the worrying symptoms I should beware of?
There are a few things that can’t wait for a routine review with your GP. If there has been trauma to the shoulder and symptoms of severe pain and weakness, if you are unable to raise the arm, or the shoulder looks to be an abnormal shape, do seek medical advice on the day.
If there are signs of infection and you have new red skin around the shoulder, if the shoulder is extremely painful to move, and if you have a fever or feel unwell, a shoulder joint infection should be excluded on the day too.
What will my GP be thinking?
If you have mild to moderate pain, your GP will want to hear the story of your symptoms and examine you. Depending on the findings, the options for investigations are generally blood tests if considering a rheumatological or inflammatory condition such as polymyalgia rheumatica or inflammatory arthritis such as rheumatoid.
If you've had a traumatic injury, or ongoing bothersome symptoms, an X-ray may identify problems with the bones, such as a fracture, or arthritis. If your GP thinks that your problem is muscular, pain relief and physiotherapy are common first steps. There are other imaging options such as ultrasound or MRI that can take a closer look at the rotator cuff muscles that surround the shoulder joint.
When will I need an expert opinion?
There are some problems where GPs need a helping hand from their hospital colleagues. If your symptoms have been present for a while since initially seeing your GP, it may be time to go back and discuss a referral. A good rule for musculoskeletal problems is a timeframe of three months to trial so-called conservative management – in this case, that’s likely to be painkillers, heat packs and physiotherapy exercises.
If your shoulder pain and ability to use the shoulder is still not improving with the advice and treatment your GP has advised, more investigations may be needed. One exception to this rule is frozen shoulder, which can take many months or even years until recovery.
What onward referral options are there?
Rheumatology GPs, orthopaedic GPs, specialist sports GPs and specialist physiotherapists all see patients referred from their GP with shoulder problems. The specialist you see will be partly down to the diagnosis your GP thinks is most likely, and also how your local area’s referral processes are set up. If you have private insurance you could discuss with your GP the most appropriate clinician to be referred to at an earlier stage.
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