The term 'shoulder impingement syndrome' did not even exist when I qualified, but I consider it to be much the same as the painful arc syndrome - and this rather long and erudite account of rotator cuff disease agrees.
The pathogenesis of rotator cuff dysfunction is discussed in perhaps too much detail, but then this is intended for the specialist.
Intrinsic and extrinsic causes are outlined, and the use of ultrasound and MRI in establishing a diagnosis are emphasised, although I suspect are little used options in the UK.
I am pleased to see that the judicious use of my favourite cocktail of lidocaine and a long-acting steroid injected into the subacromial space is still considered a useful option for GPs.
Why go there: if you want to know it all.
Downside: information is presented in a boring way.
Information from: the International Society of Arthroscopy, Knee Surgery and Orthopaedic Medicine.
This article is a good overview of the various shoulder problems a GP commonly encounters. There is a useful table of the differential diagnoses of shoulder pain, and this reminds us that causes can range from myocardial ischaemia to secondary malignancy, and is not necessarily because someone has painted the ceiling. I also like the clear line drawings.
Why go there: covers a lot of ground in a small space
Information from: Arthritis Research Campaign
I've heard of slapped face syndrome, but confess to ignorance about SLAP lesions in the shoulder and the new associated diagnostic test.
If you want to show off at your next medical society meeting, read this brief resume of superior labral antero-posterior lesions. You can't make a fool of yourself because there is still confusion over the diagnosis and clinical relevance.
SLAP lesions are common in rock-climbers, apparently.
Why go there: it's new.
Downside: uncertain future.
Information from: Manchester Sports Medicine Clinic
NOT FOR PATIENTS
I recommend this to GPs, but not patients, because it will surely amuse.
Without giving too much away, someone called Dr Becker has established that the human body has an electrical frequency that determines its health.
This should be in the range of 62-73MHz. If you've got thrush, the frequency drops to 55MHz, glandular fever, 52MHz, and if you have cancer, it's only 42MHz.
Apparently, blends of oils such as 'Angel Oils' have very high frequencies so can offer amazing benefits. The highest-frequency oils treat the lowest-frequency diseases, and shoulder pain gets a mention.
I looked up 66Mhz (the average frequency for well-being) and discovered it's the bandwidth for FM broadcasts in Lithuania (really, it is), so maybe we should all go there.
Why go there: to raise a smile
Downside: sadly someone somewhere will believe it.
Information from: Angel Oils Inc.
- Dr Barnard is a former GP in Fareham, Hampshire
WEBSITE OF THE WEEK
This site will not greatly enhance your ability to manage patients, but its images make it worth a look.
Rotator cuff tears are amenable to surgery, and this site tells you what goes on. Scroll down the strangely designed page until you get to the series of MRIs and excellent arthroscopic images.
In the picture shown, those bits of rope are actually fine braided sutures repairing a torn rotator cuff. Go through the series - it only takes a minute and there's no need to read any of the reams of text.
Why go there: intriguing.
Downside: not relevant to everyday practice.
Information from: University of Washington.