OMERACT review shows burden of shoulder disorders centres on pain

Pain is the predominant symptom reported by people with shoulder disorders but it also feeds into many of the other themes identified in a systematic review of the patient experience.

The review included eight qualitative studies representing 133 patients with disorders such as rotator cuff disease, adhesive capsulitis, proximal humeral fracture and shoulder instability. It excluded systemic inflammatory disease such as rheumatoid arthritis.

A summary of the review findings confirmed that shoulder pain impacted people’s ability to carry out activities of daily living such as dressing, hanging washing, lifting/carrying and driving.

Pain made some physical tasks at work difficult while people also reported trouble concentrating on work due to their pain. It also limited their participation in recreational activities such as sport and gardening.

“Most people with rotator cuff disease, adhesive capsulitis, proximal humeral fracture or unspecified shoulder pain reported that pain at night disrupted their sleep,” the study authors wrote.

The resultant sleep deprivation negatively impacted their concentration, memory, and emotions.

People also reported frustration, anxiety and depression related to their shoulder disorders and ‘hidden suffering’ due to the perception that other people did not see or understand what they were dealing with.

Other pathophysiological manifestations of shoulder disorders reported included reduced range of motion, loss of strength and increased muscle tension.

Co-author Professor Rachelle Buchbinder, representing the OMERACT Shoulder Core Set Working Group, told the limbic that while the review did not include people with osteoarthritis, she expected they would have similar symptoms.

“This confirms what we considered were the significant problems – that shoulder disorders cause lots of pain, limit function and interfere with sleep. Clinicians should know the main problems that patients have so they can be discussed and evaluated in the consultation.”

“We can advise about ways to maybe get more comfortable by using pillows to help with sleep or we can try and get modified duties for patients if the shoulder pain is interfering with their ability to do their job.”

“If we know they play sport, we can say ‘stop until the pain gets better’. Being holistic, we should be thinking of all these things, not just the pain.”

She said the findings have also helped inform which were the most important outcomes to measure in future shoulder trials. Ongoing work was yet to confirm which were the best instruments to measure those domains.

Professor Buchbinder added that subacromial shoulder pain should not be managed with surgery.

She said two placebo-controlled trials had shown it didn’t work, leading to a Rapid Recommendation published in the BMJ earlier this year.

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