SHOULDER PAIN

Painful shoulder is frequently a component of Personal Injury litigation, particularly following Motor Vehicle Accidents. All too often, specialists disagree on diagnosis, let alone treatment.

PRACTICE POINT

Pheumatologists commonly disagree about the diagnosis of Painful Shoulder

Three English rheumatologists, examining separately the same group of patients, achieved complete diagnostic agreement in less than half. When they together examined and discussed a similar group of patients, their separately recorded diagnoses agreed completely nearly 80% of the time[1].

PRACTICE POINT

Magnetic Resonance Imaging is generally the most accurate investigation

Italian radiologists demonstrated[2] 97% accuracy of Magnetic Resonance Imaging in predicting the
presence and severity of Rotator Cuff Tears and Impingement found at subsequent surgery.

Given the high operative success rate, orthopedic surgeons in Israel[3] propose surgical intervention
in Impingement, with or without Rotator Cuff Tear, if a few months' physical therapy is ineffective.

PRACTICE POINT

Prognosis is better after physical therapy, and little or no medication or sick leave

Ultrasound therapy was shown[4] to be ineffective in a systematic review of well-designed, randomised clinical trials, but other forms of physical therapy could not be evaluated, because of the size and quality of available research.

Norwegian researchers found[5] that active treatment with restricted prescription of painkillers and sick leave was associated with the best prognosis for Rotator Tendinosis (stage II Impingement Syndrome).