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The painful shoulder: can consultants agree?
A N Bamji1, C C Erhardt, T R Price
1Queen Mary's Hospital, Sidcup, Kent.
British Journal of Rheumatology
|November 1, 1996
Summary
Rheumatologists showed improved diagnostic agreement for shoulder pain after discussing cases together. This highlights the importance of collaborative evaluation for accurate shoulder lesion diagnosis and treatment.
Area of Science:
- Orthopedics
- Rheumatology
- Clinical Practice Audit
Background:
- Shoulder pain diagnosis and treatment can vary significantly among clinicians.
- Inter-observer variability impacts the reliability of clinical assessments in rheumatology.
Purpose of the Study:
- To evaluate diagnostic agreement among rheumatologists for shoulder pain patients.
- To assess the impact of collaborative discussion on diagnostic and treatment concordance.
Main Methods:
- A two-phase audit involving three rheumatologists examining 44 patients with shoulder pain.
- Phase 1: Separate examinations; Phase 2: Joint examination and separate diagnoses.
- Data collected included diagnoses, investigations, and treatment recommendations.
Main Results:
- Complete diagnostic agreement was 46% in Phase 1 (separate) versus 78% in Phase 2 (joint).
- Significant variation in investigation requests, but high concordance for steroid injections as treatment.
- Disagreements in Phase 1 were attributed to multiple lesions and interpretation of physical signs.
Conclusions:
- Collaborative evaluation significantly improves diagnostic agreement for shoulder pain.
- While treatment modalities like injections are concordant, diagnostic discrepancies may lead to treatment failures.
- Careful patient selection is crucial for studies on shoulder lesion treatment to avoid heterogeneity.