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Summary

Join Mr. Christopher Jukes for an in-depth teaching session, Primary Care Updates 2024: Mastering Shoulder Pain Management, aimed at helping medical professionals keep up to speed with the latest guidelines for shoulder and elbow conditions. Provided by an expert in the field, the session will cover a wide range of shoulder-related topics including diagnosis and management of neck pain, instability, impingement, rotator cuff tears, frozen shoulder, and osteoarthritis. The session will also address red flags, including the three ages of shoulder, and referrals for shoulder instability. Detailed updates will help practitioners remain proficient with the NICE, BESS/BOA recommendations, examination techniques, and advanced treatment modalities. The session is an essential resource for professionals seeking to enhance their skill set and deliver top-tier patient care.

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Description

About the MedAll Primary Care CPD Programme

We are passionate about making medical education free and more accessible. In light of the increasing financial pressures faced by healthcare professionals, including the rising cost of living and strained practice finances, we felt compelled to do something. It's why we have introduced a no-cost CPD programme for doctors, nurses and other healthcare professionals working in primary care. We recognise that the high expense of traditional CPD update courses is a significant barrier, and by collaborating as an entire primary care community we hope we can offer a practical, accessible alternative.

About our speaker: Dr Christopher Jukes

Christopher Jukes is a dedicated Clinical Fellow at Liverpool University Hospitals NHS Foundation Trust, committed to advancing patient care and medical education within the healthcare system.

Who Should Join?

✅ GPs

✅ Primary care and practice nurses

✅ Practice pharmacists

✅ Other allied healthcare professionals in primary care

Note: this event is not formally accredited by an external organisation for CPD points. The current guidance for GP CPD is that it is appropriate that the credits you self-allocate should equal however many hours you spent on learning activities, as long as they are demonstrated by a reflective note on lessons learned and any changes made or planned (if applicable).

Learning objectives

  1. To understand and describe the common causes and symptoms of shoulder pain such as instability, impingement, cuff tears, and osteoarthritis.
  2. To apply NICE guidelines in the diagnosis and treatment planning for patients with shoulder pain.
  3. To identify 'red flag' conditions in patients experiencing shoulder pain requiring urgent referral, including acute rotator cuff tear and persistent dislocation.
  4. To understand the application of physical therapy and medication in managing shoulder pain under NICE guidelines.
  5. To recognize the surgical options available for the treatment of complex shoulder conditions and when to refer for these treatments.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Primary Care Updates 2024 Mastering Shoulder Pain Management Mr Christopher Jukes BSc(Hons), MBBS, FRCS(Tr&Orth) Shoulder & Elbow Fellow Liverpool UniverUKty Hospitals NHS Foundation TrustBESS/BOA Guidelines NICE guidelines intro objectives/overview shoulder pain basic starters - neck pain / radiculopathy / trauma / infection 3 ages of the shoulder Red flags instability - wont discuss young to middle age - ACJ impingement LHB (and rupture) Frozen shoulder cuff tears OA Tennis elbow ulnar nerve Brachial neuritis Tumours3 ages of the shoulder 20’s 40’s 60’s 80’s Instability ACJ OA Subacromial Pain Frozen Shoulder Rotator Cuff GHJ OAInstabilityAtraumatic instability - Muscle patterningAtraumatic instability - Muscle patterningAtraumatic Instability NICE - Instability Physio, Physio, Physio…… Early tertiary referral for shoulder instability: • Absence from school >20% • Absence from work >3 months • Frequent A&E attendances • Persistent dislocation/subluxationDislocations in patients >40yrs Acute rotator cuff tear = 40% Refer early if suspectedLoss of external rotation •Locked posterior dislocation •Frozen Shoulder •Osteoarthritis •(Cuff tear - will allow passive movement)Where is the pain? ACJ Subacromial - LHB - Bursa - Subscapularis - CuffNot the shoulder….Shoulder examinationApprehension-Relocation O’Brien’s est Test Empty can Job’s Hawkins-Kennedy Gagey T est External rotation lag Neer Belly-Press Scarf Sulcus Sign O’Driscoll’s test Gerber’s Hornblower’s signExaminationExaminationForward Flexion AbductionExternal rotation Internal rotation“Triangle of function” ACJ Pain - Gradual onset - Activity related - Can be young (30 onwards) - Unable to sleep on that shoulder - Pain on top of shoulder - Pain above 90 and/or adduction NICE - ACJ NICE: ACJ Pain - Activity modification - Analgesia - Paracetamol (Regular) - NSAID (if helpful) - Codeine - Physiotherapy - Corticosteroid injection ACJ Pain ACJ Excision - Open vs Arthroscopic Subacromial Pain - Bursitis - Impingement - Cuff Tendinopathy - Calcific T endonitis (& Cuff tears) Cuff tendinopathy / Impingement - Insidious onset - Pain above shoulder height - Pain lifting arm away from body (Hawkins-Kennedy test)Special tests Supraspinatus Empty can (Job) testSpecial tests Infraspinatus / eres Minor External rotation - strength/lag; painSpecial tests Subscapularis Gerber’s Lift-Off est Belly PressSubacromial Pain •Analgesia •Physiotherapy BESS/BOA •Activity modification •Subacromial Injections - Blind or USS-guided - USS gives additional info and injection accuracy - 1-2 injections maximum NICECorticosteroid injections - complications - Infection - Skin de-pigmentation & thinning - Elevated blood sugars - Steroid flare - Short lasting - Possible increased risk full-thickness cuff tearsPlatelet-Rich Plasma (PRP) injections Currently no clear evidence of benefitCalcific Tendonitis - Acute/severe presentation (Exclude septic arthritis) - Diagnosed on X-ray - Refer early for US-guided barbotage and steroid injectionSubacromial pain - secondary care referral - Failed 6-8 weeks therapy - If diagnosis uncertain (or cuff tear suspected)Subacromial DecompressionAdhesive Capsulitis (Frozen Shoulder) •Insidious onset •Loss of movement • Normal x-rayGHJ injection (+/- hydrodilatation) Stiffness Pain TimePain Stiffness 6-18 months TimeAdhesive Capsulitis (Frozen Shoulder) More common & more severe in Diabetic patients Consider Diabetes in new frozen shoulder 10% = raised HbA1c NICE - Frozen shoulderRotator cuff tearsRotator cuff tears Acute tears - urgent referral Chronic tears Prevalence increases with age Majority asymptomaticCuff arthropathyLong Head Biceps Tendinopathy LHB Tendinopathy •Anterior pain •Radiates down bicep •Co-exists with or mimics cuff tear & impingementLHB Tendinopathy - Management •Analgesia •Physio •Steroid injections Accuracy: US guided = 87% Blind = 27%LHB Surgery - Tenotomy - TenodesisAcute/Spontaneous LHB Rupture - “Pop” - Pain - Bruising - Cramping - Reassurance - Physio - Consider USS - If pain persists - consider cuff GHJ Osteoarthritis • Pain • Stiffness • Range of movement • CrepitusGHJ Osteoarthritis - Activity modification Osteoarthritis - Analgesia - Paracetamol (Regular) - NSAID (if helpful) - Codeine - Physiotherapy / Occupational Therapy - Corticosteroid injection (GHJ) Refer when: - Failed conservative measures - - Significant stiffnessAnatomic Shoulder Reverse Shoulder Replacement Replacement