Service evaluation: Three subjective questions that aid in identifying frozen shoulder—Within a multi‐centre musculoskeletal physiotherapy department in primary care

Abstract

Frozen shoulder is a prevalent condition seen in primary care in the UK, 2%–10% of the general population and up to 20% of the diabetic population (Hanchard et al., 2020; Rae et al., 2019; Walker-Bone et al., 2004). Frozen shoulder is characterised by stiffness, pain, and limitation in function. Frozen shoulder is associated with variable prognosis and management strategies (Pandey & Madi, 2021; Rangan et al., 2020; Rex et al., 2021). It can be difficult to assess, diagnose and differentiate from other shoulder pathologies (Lyne et al., 2022). This is mainly due to commonality in aetiology and subjective findings in people presenting with shoulder pain. Physical examination is an integral part of frozen shoulder diagnosis. Therefore, an early identification is important to deliver good quality of care. The delivery of care in primary care settings is changing in the UK, with remote consultations on first contact becoming more prevalent in MSK settings (Rennie et al., 2022). It is also important to note that telephone assessments remain far more in number than assessments over video-based platforms in primary care settings (Murphy et al., 2021). This presents with a new set of challenges in diagnosing frozen shoulder and may cause delay in delivery of care.

There are subjective pain related complaints of frozen shoulder originally described by Codman in the 1930s and more recently by Atkin et al. (2016). These include pain constant in nature, pain on lying on the side at night and no radiating pain below the elbow. With stiffness in the shoulder being a common underlying feature. There has been a lot of research on aetiology, pathophysiology, and physical examination of frozen shoulder. However, there is a gap in the literature on exploring the relationship between key pain related subjective complaints and diagnosis of frozen shoulder.

The musculoskeletal physiotherapy service in East Lothian National Health Service, Scotland, consists of a telephone consultation to triage on first contact for self-referring patients. It was noted that pain related questions were regularly asked in these remote consultations when assessing shoulder pain; however, as discussed before, their relevance has not been evaluated in the literature in depth. Therefore, a service evaluation was carried out to investigate the relationship between three questions related to pain (i.e., Is the pain constant? Is there pain lying on the side at night? Does the pain radiate below the elbow?) and a diagnosis of frozen shoulder was made following face to face assessment. Additionally, this may help to provide some insight into whether frozen shoulder and other shoulder pathologies can be differentiated based on these pain related questions.