Shoulder disorders in general practice: Incidence, patient characteristics, and management

Danielle A.W.M. Van Der Windt*, Bart W. Koes, Bareld A. De Jong, Lex M. Bouter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

658 Citations (Scopus)


Objectives-To study the incidence and management of intrinsic shoulder disorders in Dutch general practice, and to evaluate which patient characteristics are associated with specific diagnostic categories. Methods-In 11 general practices (35 150 registered patients) all consultations concerning shoulder complaints were registered during a period of one year. Patients with an intrinsic shoulder disorder who had not consulted their general practitioner for the complaint during the preceding year (incident cases) were asked to participate in an observational study. Participants completed a questionnaire regarding the nature and severity of their complaints. The general practitioners recorded data on diagnosis and therapy. Results-The cumulative incidence of shoulder complaints in general practice was estimated to be ll2/1000 patients/year (95% confidence limits 10.1 to 12.3). Rotator cuff tendinitis was the most frequently recorded disorder (29%). There were 349 incident cases enrolled in the observational study. Patient characteristics showed small variations between different diagnostic categories. Age, duration ofsymptoms, precipitating cause and restriction ofmovement seemed to be discriminating factors. Twenty two percent of all participants received injections during the first consultation; most (85%) were diagnosed as having bursitis. The majority of patients with tendinitis (53%) were referred for physiotherapy. Conclusion-With respect to diagnosis and treatment, the practitioners generally appeared to follow the guidelines issued by the Dutch College of General Practitioners. Although the patient characteristics of specific disorders showed some similarities with the clinical pictures described in the literature, further research is required to demonstrate whether the proposed syndromes indeed constitute separate disorders with a different underlying pathology, requiring different treatment strategies.

Original languageEnglish
Pages (from-to)959-964
Number of pages6
JournalAnnals of the Rheumatic Diseases
Issue number12
Publication statusPublished - 1995


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