Rheumatology Advance Access originally published online on November 1, 2005
Rheumatology 2006 45(2):215-221; doi:10.1093/rheumatology/kei139
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Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral
1 Division of Public Health and Primary Health Care and 2 Wellcome Trust Centre for Human Genetics, University of Oxford and 3 Nuffield Orthopaedic Centre, Oxford, UK.
Correspondence to: L. Linsell, Medical Statistician, Centre for Statistics in Medicine, Wolfson College Annexe, Linton Road, Oxford OX2 6UD, UK. E-mail: louise.linsell{at}cancer.org.uk
Objectives. To estimate the national prevalence and incidence of adults consulting for a shoulder condition and to investigate patterns of diagnosis, treatment, consultation and referral 3 yr after initial presentation.
Methods. Prevalence and incidence rates were estimated for 658469 patients aged 18 and over in the year 2000 using a primary care database, the IMS Disease Analyzer–Mediplus UK. A cohort of 9215 incident cases was followed-up prospectively for 3 yr beyond the initial consultation.
Results. The annual prevalence and incidence of people consulting for a shoulder condition was 2.36% [95% confidence interval (CI) 2.32–2.40%] and 1.47% (95% CI 1.44–1.50%), respectively. Prevalence increased linearly with age whilst incidence peaked at around 50 yr then remained static at around 2%. Around half of the incident cases consulted once only, while 13.6% were still consulting with a shoulder problem during the third year of follow-up. During the 3 yr following initial presentation, 22.4% of patients were referred to secondary care, 30.8% were prescribed non-steroidal anti-inflammatory drugs and 10.6% were given an injection by their general practitioner (GP). GPs tended to use a limited number of generalized codes when recording a diagnosis; just five of 426 possible Read codes relating to shoulder conditions accounted for 74.6% of the diagnoses of new cases recorded by GPs.
Conclusions. The prevalence of people consulting for shoulder problems in primary care is substantially lower than community-based estimates of shoulder pain. Most referrals occur within 3 months of initial presentation, but only a minority of patients are referred to orthopaedic specialists or rheumatologists. GPs may lack confidence in applying precise diagnoses to shoulder conditions.
KEY WORDS: Shoulder, Consultation, Prevalence, Incidence, Diagnosis, Referral, Primary care
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