New guidance encourages GPs and physiologists to ditch unnecessary shoulder scans
Monash University researchers have reviewed existing evidence and concluded that most shoulder problems get better with self-management, education and time, challenging widespread clinical reliance on early imaging and surgical interventions. The landmark review, published in JAMA Internal Medicine, provides general practitioners and physiotherapists with an updated roadmap for managing shoulder…
The majority of shoulder issues resolve with self-management techniques, education, and time, contradicting the common practice of immediately resorting to scans and surgery, according to a study published in JAMA Internal Medicine. This comprehensive review, conducted by researchers at Monash University, provides healthcare practitioners with updated recommendations for handling shoulder pain.
The majority of adults experience shoulder pain at some point, which is the third most frequent musculoskeletal problem in primary care, following back and knee issues. Routine scans, such as X-rays, ultrasounds, or MRIs, are not advised for most cases, as abnormalities on scans frequently do not correlate with the patient's pain.
Instead, clinicians should concentrate on comprehending the patient's symptoms and medical history, performing a physical examination, offering reassurance regarding recovery, and suggesting activity modifications, pain relief, or monitoring the condition. The initial assessment should aim to rule out severe underlying causes, such as infections, tumors, or bone fractures, and differentiate localized shoulder pain from pain referred from the neck or heart.
Dr. Romi Haas, a researcher at Monash University, emphasized that physicians should look beyond structural flaws and recognize that many findings are typical age-related changes, similar to gray hair or wrinkles. Early scans can lead to unnecessary anxiety, misdiagnosis, and unnecessary treatments. The location-based designation of subacromial pain helps reassure patients that it is safe to continue moving while managing their symptoms.
Co-author Dr. Thomas Ibounig noted that a common shoulder surgery, which involves removing bone and tissue to create more space for tendons, provides no significant advantage over a sham procedure where incisions are made but no repairs are made. This evidence underscores that pain is not always caused by an anatomical or structural issue that can be easily rectified through surgery.
The guidance also addresses corticosteroid injections, which can offer temporary pain relief but are not typically recommended based on imaging. Evidence shows that injections performed by doctors based on the patient's anatomy provide similar results without the extra cost or inconvenience of imaging. According to Professor Rachelle Buchbinder, a senior author, most individuals recover from shoulder pain within a year, although some recover more quickly.
Based on a long-term study involving 526 adults with new shoulder concerns, almost 80% experienced significant improvement through watchful waiting or anti-inflammatory medication. The new guidance serves as a practical tool and a reassuring reminder for healthcare professionals, offering an evidence-based approach to reassure patients that self-management, time, and targeted advice are typically the safest and most effective methods for recovery.
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