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Shoulder pain - Management
Basis for recommendation
- CKS has based the timescale for referral on a number of sources. A New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders suggests referral to orthopaedics if tendinosis symptoms fail to improve at 6 months or longer [NZGG, 2004]. One review suggested that if the rotator cuff is thought to be intact (i.e. no tear is suspected) a 3–6 month trial of conservative treatment is considered adequate before referral [Burbank et al, 2008], and another suggested referral if the person has persistent pain after a 3-month course of physical therapy [Codsi, 2007].
- If a large tear is suspected (e.g. the person has a history of acute trauma, weakness, or active elevation < 120 degrees) a magnetic resonance imaging (MRI) scan should be obtained and a prompt referral is indicated [Iannotti and Kwon, 2005; Codsi, 2007; Burbank et al, 2008].
- Urgent referral if red flag features are present is recommended in an article on the management of shoulder disorders in primary care [Mitchell et al, 2005].
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