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Shoulder pain - Management
Basis for recommendation
- A New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders [NZGG, 2004] and an article on the management of shoulder pain in primary care [Mitchell, 2008] recommend referral of frozen shoulder if there is diagnostic uncertainty, or red flag features.
- The need for surgical intervention (e.g. manipulation under anaesthesia [MUA] or arthroscopic capsular release) is rare and referral is not indicated until the person has failed 6 months of non-operative treatment, or if the diagnosis is in question [Burbank et al, 2008].
- MUA may be effective, but subsequent mobilization through physiotherapy is essential. Fractured humerus is a recognized complication of MUA, however [Hazleman, 2005]. A review advises referral for MUA if the person cannot tolerate the pain and disability of frozen shoulder [Dias et al, 2005].
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