Shoulder Pain Management
Selecting an Orthopaedic Specialist
Although orthopaedic surgeons know all parts of the musculoskeletal system, many specialize in specific anatomic areas such as the shoulder. They treat musculoskeletal conditions with medications, exercise and other rehabilitative therapies. In some instances, they may find it necessary to recommend surgical treatment. Consider referring to an orthopaedic surgeon who specializes in shoulder (upper extremity) anatomy.
For the general practitioner, referral to an orthopaedic shoulder specialist may be advised if:1
- The patient has pain and significant disability lasting beyond 32 to 6 months despite administration of conservative interventions; i.e., analgesics, steroids and physiotherapy.
- There is diagnostic uncertainty or “red flags” such as:
- Presence of diabetes.
- Trauma – acute disabling pain and significant weakness, positive drop arm test.
- Unexplained deformity, mass or swelling.
- Red skin, fever, systemically unwell.
- Unexplained significant sensory or motor deficit.
- The patient has a history of shoulder instability.
When you refer patients to an orthopaedic specialist, consider doctors who specialize in the shoulder. You can search for orthopaedic shoulder specialists (shoulder surgeons) by visiting the Surgeon Locator. Other resources which may be helpful are the American Academy of Orthopaedic Surgeons (http://www.aaos.org) and the American Shoulder and Elbow Surgeons Association (http://www.ases-assn.org).
When evaluating shoulder specialists for patient referrals, you should consider:
- The shoulder specialist should be board certified and fellowship trained. Look for board certification by the American Board of Orthopaedic Surgeons or the American Osteopathic Surgery Board.
- Look for subspecialties such as arthroscopic rotator cuff repair, arthroscopic shoulder stabilization, shoulder replacement and shoulder revision.
- Find out how often the shoulder surgeon performs different shoulder procedures and how many years he/she has performed shoulder surgeries.
- Talk with surgeons about their surgical results.
To locate an orthopaedic shoulder specialist near you, click on the Surgeon Locator.
- Mitchell C, Adebajo A, Hay E, Carr A. “Shoulder Pain: Diagnosis and Management in Primary Care.” BMJ. 2005;331:1124-1128.
- Codsi MJ. “The Painful Shoulder: When to Inject and When to Refer.” Cleve Clin J Med. 2007;74:473-474, 477-478, 480-472 passim.