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Management in non-traumatic arm, neck and shoulder complaints: differences between diagnostic groups
Anita Feleus1, Sita M A Bierma-Zeinstra, Harald S Miedema
1Department of General Practice, Erasmus MC, Room Wk121, PO Box 2040, 3000 CA Rotterdam, The Netherlands. a.feleus@erasmusmc.nl
Summary
Management of non-traumatic arm, neck, and shoulder complaints varied. Specific diagnoses often led to specialist referrals and corticosteroid injections, while non-specific cases typically received physiotherapy.
Area of Science:
- Musculoskeletal disorders
- General practice
- Epidemiology
Background:
- Arm, neck, and shoulder (ANS) complaints are prevalent in Western societies.
- Current Dutch general practice guidelines inadequately cover the full spectrum of ANS diagnoses.
- Understanding the real-world management of these conditions is crucial.
Purpose of the Study:
- To describe the management of new-episode, non-traumatic ANS complaints in general practice.
- To analyze management differences based on specific versus non-specific diagnoses.
- To compare management strategies across different specific diagnostic groups.
Main Methods:
- Prospective cohort study involving 682 general practice patients with new ANS complaints.
- Data collection on diagnosis, management, patient, and complaint characteristics.
- Analysis of treatment patterns up to six months post-initial consultation.
Main Results:
- 18% of patients underwent further diagnostic tests (14% radiographic).
- 49% were referred for physiotherapy; 12% to a medical specialist.
- Specific diagnoses received more specialist referrals and corticosteroid injections (17%); non-specific diagnoses more physiotherapy.
- Medication (51%) and brace prescriptions (4%) showed no significant diagnostic group differences.
Conclusions:
- Management of non-traumatic ANS complaints in general practice is diverse.
- Treatment pathways differ significantly between specific and non-specific diagnoses.
- Physiotherapy and analgesics are common, while specialist referrals and injections are more diagnosis-dependent.