Healthcare Use Patterns for High Volume Musculoskeletal Shoulder Disorders: A Longitudinal Cohort from the US...

Area of Science:

• Orthopedics
• Musculoskeletal Disorders
• Healthcare Utilization

Background:

• Shoulder injuries are common musculoskeletal disorders requiring healthcare.
• Understanding healthcare system utilization for shoulder disorders is crucial.
• Patterns of diagnostic imaging and treatment for shoulder pain are not well-defined.

Purpose of the Study:

• To describe the frequency and timing of diagnostic imaging and treatment for new shoulder pain episodes.
• To determine variations in healthcare utilization across diagnostic subgroups and care settings (military vs. civilian).

Main Methods:

• Retrospective cohort study of 456,241 US Military Health System beneficiaries.
• Patients classified into 7 diagnostic subgroups (e.g., rotator cuff, instability, osteoarthritis).
• Healthcare encounters within 3 months analyzed for diagnostic imaging, pharmacological, and non-pharmacological treatments.

Main Results:

• 76.7% of patients did not receive diagnostic imaging; advanced imaging was more common in the multiple diagnoses group.
• Non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy were the most common treatments.
• Civilian clinics showed lower physical therapy use and higher imaging use (MRI/X-ray) compared to military clinics for similar diagnoses.
• Steroid joint injections were more frequent in civilian clinics for rotator cuff, multiple diagnoses, and hypomobility disorders.

Conclusions:

• Shoulder injury care patterns are largely similar between military and civilian clinics.
• Significant variations exist in imaging, steroid injections, and physical therapy use for specific shoulder diagnoses based on care setting.