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Musculoskeletal shoulder complaints: characteristics of patients and consultations in primary care

ABSTRACT

Shoulder pain is the third most common musculoskeletal complaint of the world population. It affects the physical, psychological and financial situation of the individual. Primary care is essential to an effective health care for affected patients. This cross-sectional and observational study has the purpose of characterizing the profile of users of the primary health care service, and analyzing the medical records with shoulder pain reports over an one-year period in the primary care service of Ribeirão Preto - SP. Medical records of patients with scheduled and unscheduled medical consultations were analyzed. Data from patients with musculoskeletal shoulder pain - sociodemographic data and the consultation characteristics - were collected and analyzed descriptively and by Pearson’s Chi-squared test, Odds Ratio and Multiple Logistic Regression. The frequency of shoulder pain in the primary care was 9.2%. The profile of individuals who complained about shoulder pain was advanced age, married, literate and working women. Most consultations had scheduled follow-up consultations, therapeutic guidance and few referrals.

Keywords
Musculoskeletal Pain; Shoulder; Primary Health Care

RESUMO

A dor no ombro representa a terceira principal queixa musculoesquelética da população. Afeta fatores físicos, psicológicos e econômicos do indivíduo. A atenção primária à saúde é essencial para a eficácia do cuidado dos pacientes acometidos. Este estudo é observacional transversal e obteve um perfil dos usuários e das consultas médicas com relato de dor no ombro durante um ano na atenção primária do município de Ribeirão Preto (SP). Foram analisados em prontuários os registros das consultas médicas agendadas e sem agendamento prévio. Nestes registros foram coletados dados dos pacientes que apresentaram queixas de dor musculoesquelética no ombro (dados sociodemográficos e características das consultas), que foram analisados de forma descritiva e pelos testes qui-quadrado de Pearson, razão de chance e regressão logística múltipla. A frequência de consultas médicas por queixa de dor no ombro foi de 9,2%. O perfil dos indivíduos que se queixaram de dor no ombro se caracterizava por mulheres, com idade avançada, casadas, alfabetizadas e que apresentavam alguma ocupação. As consultas em sua maioria tiveram retornos agendados, oferecimento de orientações terapêuticas e poucos encaminhamentos.

Descritores:
|Dor Musculoesquelética; Ombro; Atenção Primária à Saúde

RESUMEN

El dolor en el hombro representa la tercera principal queja musculoesquelética de la población. Acomete los factores físicos, psicológicos y económicos del individuo. La atención primaria a la salud es esencial para la eficacia del cuidado de los pacientes afectados. Este estudio de tipo observacional transversal obtuvo un perfil de los usuarios y de las consultas médicas en que había relato de dolor en el hombro durante un año en la atención primaria del municipio de Ribeirão Preto (SP). Se analizaron los registros de las consultas médicas programadas y sin programación previa. En estos registros se recolectaron los datos de los pacientes que se quejaban de dolor musculoesquelético en el hombro (sus datos sociodemográficos y las características de las consultas), los cuales fueron analizados de forma descriptiva y por la prueba chi-cuadrado de Pearson, por las razones de prevalencia y por la regresión logística múltiple. La frecuencia de consultas médicas por queja de dolor en el hombro fue del 9,2%. El perfil de los individuos que se quejaron de dolor en el hombro fue de mujeres, con edad avanzada, casadas, alfabetizadas y que se dedicaban a alguna actividad. Las consultas en su mayoría tuvieron retornos programados, ofrecimiento de orientaciones terapéuticas y pocos encaminamientos.

Palabras clave:
|Dolor Musculoesquelético; Hombro; Atención Primaria de Salud

INTRODUCTION

Non-communicable chronic diseases have become a priority in the health area of countries such as Brazil11. Schmidt MI, Duncan BB, Silva GA, Menezes AM, Monteiro CA, Barreto SM, et al. Doenças crônicas não transmissíveis no Brasil: carga e desafios atuais. Lancet. 2011;377(9781):1949-61. doi: 10.1016/S0140-6736(11)60135-9
https://doi.org/10.1016/S0140-6736(11)60...
),(22. Malta DC, Stopa SR, Szwarcwald CL, Gomes NL, Silva Júnior JB, Reis AAC. A vigilância e o monitoramento das principais doenças crônicas não transmissíveis no Brasil - Pesquisa Nacional de Saúde, 2013. Rev Bras Epidemiol. 2015;18(suppl 2):3-16. doi: 10.1590/1980-5497201500060002
https://doi.org/10.1590/1980-54972015000...
. Among these chronic diseases, musculoskeletal disorders occupy the fourth position in years of life lost adjusted by disability33. Global Burden of Disease Study 2013 Collaborators. Europe PMC Funders Group Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study. Lancet. 2015;386(9995):743-800. doi: 10.1016/S0140-6736(15)60692-4
https://doi.org/10.1016/S0140-6736(15)60...
),(44. Smith E, Hoy DG, Cross M, Vos T, Naghavi M, Buchbinder R, et al. The global burden of other musculoskeletal disorders: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(8):1462-9. doi: 10.1136/annrheumdis-2013-204680
https://doi.org/10.1136/annrheumdis-2013...
. In international studies that investigated musculoskeletal disorders, shoulder pain is the third major complaint of the poplation55. Kinge JM, Knudsen AK, Skirbekk V, Vollset SE. Musculoskeletal disorders in Norway: Prevalence of chronicity and use of primary and specialist health care services. BMC Musculoskelet Disord. 2015;16(1):1-9. doi: 10.1186/s12891-015-0536-z
https://doi.org/10.1186/s12891-015-0536-...
, given that complaints from the subacromial space structures represented 44% to 80%66. Greving K, Dorrestijn O, Winters JC, Groenhof F, Van Der Meer K, Stevens M, et al. Incidence, prevalence, and consultation rates of shoulder complaints in general practice. Scand J Rheumatol. 2012;41(2):150-5. doi: 10.3109/03009742.2011.605390
https://doi.org/10.3109/03009742.2011.60...
),(77. Roe Y, Soberg HL, Bautz-Holter E, Ostensjo S. A systematic review of measures of shoulder pain and functioning using the International classification of functioning, disability and health (ICF). BMC Musculoskelet Disord. 2013;14(1):1. doi: 10.1186/1471-2474-14-73
https://doi.org/10.1186/1471-2474-14-73...
.

Values for annual incidence and prevalence vary across countries. The prevalence of cervical and shoulder pain in population studies was 55.6% in Japan and 23.3% in the United Kingdom88. Iizuka Y, Iizuka H, Mieda T, Tajika T, Yamamoto A, Ohsawa T, et al. Association between neck and shoulder pain, back pain, low back pain and body composition parameters among the Japanese general population Epidemiology of musculoskeletal disorders. BMC Musculoskelet Disord. 2015;16(1):1-10. doi: 10.1186/s12891-015-0759-z
https://doi.org/10.1186/s12891-015-0759-...
),(99. Macfarlane GJ, Beasley M, Smith BH, Jones GT, Macfarlane TV. Can large surveys conducted on highly selected populations provide valid information on the epidemiology of common health conditions? An analysis of UK Biobank data on musculoskeletal pain. Br J Pain. 2015;9(4):203-12. doi: 10.1177/2049463715569806
https://doi.org/10.1177/2049463715569806...
. One study reports data indicating that the mean incidence of patients with shoulder complaints was 29.3% per 1,000 people/year during a 9-year period in the Netherlands, and that the prevalence ranges from 41.2% to 48.4%66. Greving K, Dorrestijn O, Winters JC, Groenhof F, Van Der Meer K, Stevens M, et al. Incidence, prevalence, and consultation rates of shoulder complaints in general practice. Scand J Rheumatol. 2012;41(2):150-5. doi: 10.3109/03009742.2011.605390
https://doi.org/10.3109/03009742.2011.60...
. Another population study conducted in the Netherlands and the United Kingdom reported incidence rates ranging from 11.2% to 29.5% and prevalence data from 4.7% to 46.7%1010. Picavet HS, G Schouten JSA. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1-2):167-78.),(1111. Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R, et al. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology. 2006;45(2):215-21. doi: 10.1093/rheumatology/kei139
https://doi.org/10.1093/rheumatology/kei...
. In Brazil, most of the studies that investigated musculoskeletal pain in the shoulder evaluated specific occupations, and no studies of the population or health services were found1212. Almeida MO, Hespanhol LC, Lopes AD. Prevalence of Musculoskeletal Pain Among Swimmers in an Elite National Tournament. Int J Sports Phys Ther. 2015),(1313. Müller JS, Falcão IR, Couto MCBM, Viana WS, Alves IB, Viola DN, et al. Artisanal fisherwomen/shellfish gatherers: analyzing the impact of upper limb functioning and disability on health-related quality of life. Cien Saude Colet. 2017;22(11):3635-44. doi: 10.1590/1413-812320172211.13392016
https://doi.org/10.1590/1413-81232017221...
.

National studies investigating the demand for medical consultations in primary care indicate pain as the main reason for seeking this service, and musculoskeletal discomfort is the type of pain most frequently reported, with prevalence ranging from 14.5% to 15.7%1414. Trindade KMC, Schmitt ACB, Casarotto RA. Queixas musculoesqueléticas em uma unidade básica de saúde: implicações para o planejamento das ações e fisioterapia. Fisioter Pesqui. 2013;20(3):228-34. doi: 10.1590/S1809-29502013000300006
https://doi.org/10.1590/S1809-2950201300...
),(1515. De Torres RCS, Marques KS, De Leal KNR, Rocha-Filho PAS. Principais motivos de consultas médicas em unidades de saúde da família na cidade do Recife, Brasil: um estudo transversal. São Paulo Med J. 2015;133(4):367-70. doi: 10.1590/1516-3180.2014.9490902
https://doi.org/10.1590/1516-3180.2014.9...
. Little is known about the extent of shoulder pain cases in primary care in Brazil, which complicates the identification of the population’s health needs and the subsequent intervention planning.

The initial steps to diagnose and treat the patient with shoulder pain in primary care may be essential for the effectiveness of health care, reducing the number of surgical repair procedures for tendons, and reducing the costs for society. Therefore, epidemiological studies in primary care on musculoskeletal pain in the shoulder are established as relevant. Thus, this study analyzed the users and the medical consultations with shoulder pain report during a year in the primary care of Ribeirão Preto (SP).

METHODOLOGY

This cross-sectional and observational study was held for one year in three of the six Family Health Centers (NSFs - Núcleos de Saúde da Família) located in the Western district of the city of Ribeirão Preto. The study followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology1616. Malta M, Cardoso LO, Bastos FI, Magnanini MMFC, Silva MFP. STROBE initiative: guidelines on reporting observational studies. Rev Saúde Pública. 2010;44(3):559-65. doi: 10.1590/1980-5497201500060002
https://doi.org/10.1590/1980-54972015000...
and was approved by the local Ethics Committee, under opinion number 40772214.9.0000.5414.

The collection was performed by a single person that attended the centers and analyzed in paper medical records the registry of planned (scheduled) and occasional (unscheduled) consultations in NSFs from January 2014 to January 2015. Data collected were from patients who presented complaints of musculoskeletal pain in the shoulder, excluding patients with information on the medical record of pain originating from neurological or vascular disorders and neoplasia. Data on sociodemographic information, diagnostic hypothesis, type of consultation and characteristics of the consultation were collected.

The simple descriptive analysis of data was held in relation to the sociodemographic data, characteristics of consultations and referrals to other specialties in the health area, extracting means and absolute numbers. Occupations were classified as: active with demand of the upper extremity (required manipulation of objects with elevation of the upper extremity); active without demand of the upper extremity; and retirees.

Pearson’s chi-square test was used to verify association between nominal variables by comparing the proportions of clinical diagnosis of subacromial impingement syndrome (SIS and others), clinical diagnosis of osteoarthritis (osteoarthritis and others), prescription of guidelines (yes and no) and referrals for physical therapy (yes and no) between groups of adults and older persons. Analyses of the Pearson’s chi-square test were held with a significance level of 0.05. Odds ratios with a 95% confidence interval were used to verify the magnitude of the association between these variables. The odds ratio was assessed using the following categories: an odds ratio of 1 indicates that the condition or event under study is equally likely to occur in both groups; an odds ratio >1 indicates that the condition or event is more likely to occur in the adult group; finally, an odds ratio <1 indicates that the probability is lower in the adult group than in the older persons group.

Multiple logistic regression analysis was performed to determine the predictors of referral for physical therapy, which represented a binary dependent variable. The independent variables were: age (up to 59 years or ≥60 years), sex (female or male), level of education (literate or illiterate), marital status (with partner or without partner), occupation in three aforementioned categories, diagnostic hypothesis (SIS, osteoarthritis and without diagnosis) and presence of medical guidance (yes or no). For the regression model, the independent variables with association to the dependent variable in the Spearman’s correlation were selected. The significance level in the correlation and regression analyses was 0.05. Regression analyses were performed in the Statistical Package for the Social Sciences version 17 for Windows (SPSS Inc., Chicago, IL).

RESULTS

During the study period, 7,298 medical records were analyzed considering the scheduled and unscheduled medical consultations in the centers. Of these medical records, 1,087 (100.0%) were related to complaints of musculoskeletal pain, of which 117 (9.2%) were related to complaints in the shoulder region. Of the appointments for shoulder pain complaints, 79.2% were scheduled, and 20.8% were unscheduled.

After stratifying these data by age group, the results showed an increase in shoulder pain complaints as the population ages. The highest demands for care were by literate and married women. Thirty-one work situations and 20 different diagnoses were described (Table 1).

Table 1
Absolute (n) and relative (%) values of sociodemographic data and diagnostic hypothesis. Ribeirão Preto (SP), Brazil, 2014

Figure 1 presents data from the first medical consultation and shows that approximately 59% of the patients received the diagnostic hypothesis at that time (Figure 1A), 53% received some kind of therapeutic guidance provided by the doctor (Figure 1B) and only 11% of the patients were referred to physical therapy (Figure 1C).

Figure 1
Descriptive data of the first consultation regarding the frequency of patients who received a diagnostic hypothesis at that time (1A), those who received some kind of therapeutic guidance provided by the doctor (1B) and those who were referred to physical therapy (1C)

The therapeutic guidance was the most practiced conduct, being prescribed in 60.6% of consultations, with indication of rest, guidance on positioning, use of thermal resources, stretching, nutrition reeducation and physical activity. Most patients had a scheduled follow-up consultation in the center, and only 16 were referred to physical therapy (Table 2).

Table 2
Absolute (n) and relative (%) values of medical conduct data. Ribeirão Preto (SP), Brazil, 2014

Comparisons between groups of adults and older persons showed no evidence of difference in proportions or association with increased odds for clinical diagnoses, medical guidance conducts and referrals for physical therapy in the appointments (Table 3).

Table 3
Absolute (n) and relative (%) values for data on consultations of older persons and adults. Ribeirão Preto (SP), Brazil, 2014

The association between referral for physical therapy and sociodemographic variables was observed for level of education, diagnostic hypothesis and guidance prescription. Multiple logistic regression analysis included in the model these three variables and showed that the variables level of education and guidance prescription influenced the doctor’s decision in referring the patient to physical therapy. Level of education presented a directly proportional relation (B=2.425, p=0.041), whereas the guidance prescription variable had an inversely proportional relation (B=-3.505, p=0.000). The variable diagnostic hypothesis did not influence the decision of referral to physical therapy (B=-18.031, p=0.09).

DISCUSSION

This study showed that the frequency of medical consultations due to shoulder pain complaints in the NSFs studied was 9.2% in a one-year period. This percentage is below the world prevalence and incidence rates1010. Picavet HS, G Schouten JSA. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1-2):167-78.),(1111. Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R, et al. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology. 2006;45(2):215-21. doi: 10.1093/rheumatology/kei139
https://doi.org/10.1093/rheumatology/kei...
.

Most consultations held during this period were scheduled and had a follow-up visit as conduct, corroborating the principles of primary care for continuity of care (logitudinality) and bonding1717. Brasil. Ministério da Saúde. Secretaria de Atenção á Saúde. Departamento de Atenção Básica. Política Nacional de Atenção Básica. Brasília: Ed. Ministério da Saúde, 2012.. Another study also showed that approximately 60% of consultations in primary care were held through planned demands1818. Gusso GDF. Diagnóstico da demanda em Florianópolis utilizando a Classificação Internacional da Atenção Primária, 2ª edição (CIAP-2) [tese]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2009..

Most users with shoulder pain who attended consultations were older persons. Evidence in the literature suggests that the increase of age is proportional to the number of musculoskeletal complaints, as well as those of shoulder pain1818. Gusso GDF. Diagnóstico da demanda em Florianópolis utilizando a Classificação Internacional da Atenção Primária, 2ª edição (CIAP-2) [tese]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2009., which are more common in individuals of middle1919. Shanahan EM, Sladek R. Shoulder pain at the workplace. Best Pract Res Clin Rheumatol. 2011;25(1):59-68. doi: 10.1016/j.berh.2011.01.008
https://doi.org/10.1016/j.berh.2011.01.0...
),(2020. LeResche L, Saunders K, Dublin S, Thielke S, Merrill JO, Shortreed SM, et al. Sex and age differences in global pain status among patients using opioids long term for chronic noncancer pain. J Women's Heal. 2015;24(8):629-35. doi: 10.1089/jwh.2015.5222
https://doi.org/10.1089/jwh.2015.5222...
and advanced aged2121. Houde F, Cabana F, Léonard G. Does age affect the relationship between pain and disability? A descriptive study in individuals suffering from chronic low back pain. J Geriatr Phys Ther. 2016;39(3):140-5. doi: 10.1519/JPT.0000000000000055
https://doi.org/10.1519/JPT.000000000000...
.

There is also a pattern among those who complain about shoulder pain, are concerned about and regularly seek health services, and usually present a double work shift and home services: they are women. This result has already been demonstrated in several other studies on musculoskeletal disorders2222. Chen B, Li L, Donovan C, Gao Y, Ali G, Jiang Y, et al. Prevalence and characteristics of chronic body pain in China: a national study. Springerplus. 2016;5:938. doi: 10.1186/s40064-016-2581-y
https://doi.org/10.1186/s40064-016-2581-...
),(2323. Oliva EM, Midboe AM, Lewis ET, Henderson PT, Dalton AL, Im JJ, et al. Sex differences in chronic pain management practices for patients receiving opioids from the veterans health administration. Pain Med (United States). 2015;16(1):112-8. doi: 10.1111/pme.12501
https://doi.org/10.1111/pme.12501...
and on shoulder disorders2424. Boerner KE, Schinkel M, Chambers CT. It is not as simple as boys versus girls: the role of sex differences in pain across the lifespan. Pain Manag. 2015;5(1):1-4. doi: 10.2217/pmt.14.42
https://doi.org/10.2217/pmt.14.42...
.

Shoulder pain was associated with occupation, even to those that did not demand the upper extremity directly. Other studies have also shown that shoulder pain may be related to occupation2525. Dorrestijn O, Greving K, van der Veen WJ, van der Meer K, Diercks RL, Winters JC, et al. Patients with shoulder complaints in general practice: consumption of medical care. Rheumatology. 2011;50(2):389-95. doi: 10.1093/rheumatology/keq333
https://doi.org/10.1093/rheumatology/keq...
),(2626. Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, et al. General practice activity in Australia 2014-15. General practice series no. 38. Sydney University Press; 2015 [cited 2019 Jan 29]. Available from: http://sydney.edu.au/medicine/fmrc/publications/BEACH-feature-chapter-2015.pdf
http://sydney.edu.au/medicine/fmrc/publi...
, indicating that both physical risk factors that directly involve the shoulder2727. Sim J, Lacey RJ, Lewis M. The impact of workplace risk factors on the occurrence of neck and upper limb pain: a general population study. BMC Public Health. 2006;6:1-10. doi: 10.1186/1471-2458-6-234
https://doi.org/10.1186/1471-2458-6-234...
),(2828. Eltayeb S, Staal JB, Hassan A, De Bie RA. Work related risk factors for neck, shoulder and arms complaints: a cohort study among Dutch computer office workers. J Occup Rehabil. 2009;19(4):315-22. doi: 10.1007/s10926-009-9196-x
https://doi.org/10.1007/s10926-009-9196-...
and psychosocial factors2929. Silverstein BA, Bao SS, Fan ZJ, Howard N, Smith C, Spielholz P, et al. Rotator cuff syndrome: personal, work-related psychosocial and physical load factors. J Occup Environ Med. 2008;50(9):1062-76. doi: 10.1097/JOM.0b013e31817e7bdd
https://doi.org/10.1097/JOM.0b013e31817e...
may be associated with pain complaint.

After analyzing the consultation characteristics, the diagnostic hypothesis was established for most patients already in the first consultation. A different result was found in the study by Dorrestijn et al.2424. Boerner KE, Schinkel M, Chambers CT. It is not as simple as boys versus girls: the role of sex differences in pain across the lifespan. Pain Manag. 2015;5(1):1-4. doi: 10.2217/pmt.14.42
https://doi.org/10.2217/pmt.14.42...
, in which only 14% of the patients that attended consultations due to shoulder pain complaints with their general doctors had a diagnostic hypothesis established at the first visit. Also in opposition to the result of this research, some national studies have shown that only 50% of primary care demand is susceptible to diagnosis1818. Gusso GDF. Diagnóstico da demanda em Florianópolis utilizando a Classificação Internacional da Atenção Primária, 2ª edição (CIAP-2) [tese]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2009..

In this study, the following diagnostic hypothesis determined in the consultation were highlighted: SIS, tendinitis, bursitis and osteoarthritis. Other studies have found different diagnoses because of the international destandardization of diagnoses2424. Boerner KE, Schinkel M, Chambers CT. It is not as simple as boys versus girls: the role of sex differences in pain across the lifespan. Pain Manag. 2015;5(1):1-4. doi: 10.2217/pmt.14.42
https://doi.org/10.2217/pmt.14.42...
.

Therapeutic guidance was the medical conduct most used in relation to the prescription of drugs and the request of examinations. Contrary to this result, a study in primary care of the Netherlands indicated the prescription of drugs as the most common conduct of the consultations2424. Boerner KE, Schinkel M, Chambers CT. It is not as simple as boys versus girls: the role of sex differences in pain across the lifespan. Pain Manag. 2015;5(1):1-4. doi: 10.2217/pmt.14.42
https://doi.org/10.2217/pmt.14.42...
.

Among the referrals to different specialties, physical therapy and orthopedics were highlighted, and 86% received no referral. Considering the resolutiveness level of primary care, only 20% of the demand is admitted to referral1414. Trindade KMC, Schmitt ACB, Casarotto RA. Queixas musculoesqueléticas em uma unidade básica de saúde: implicações para o planejamento das ações e fisioterapia. Fisioter Pesqui. 2013;20(3):228-34. doi: 10.1590/S1809-29502013000300006
https://doi.org/10.1590/S1809-2950201300...
.

The comparison between the groups of older persons and adults showed no differences in the proportions of clinical diagnoses, medical guidance conducts and referrals for physical therapy in the consultations. Regarding the odds ratio, a descriptive association with a greater chance of adults presenting SIS (19%), osteoarthritis (11%), guidance (35%) and referral (81%) could be verified. Even though not supported by the confidence interval, these differences in odds may be clinically relevant. In a study2424. Boerner KE, Schinkel M, Chambers CT. It is not as simple as boys versus girls: the role of sex differences in pain across the lifespan. Pain Manag. 2015;5(1):1-4. doi: 10.2217/pmt.14.42
https://doi.org/10.2217/pmt.14.42...
, the group of older persons had a lower referral rate by consultations, and a US study3030. Andersen JH, Haahr JP, Frost P. Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population. Arthritis Rheum. 2007;56(4):1355-64. doi: 10.1002/art.22513
https://doi.org/10.1002/art.22513...
showed that older patients are less likely to be referred to physical therapy or secondary care services compared to younger patients.

Referral to physical therapy and prescription of guidelines were inversely related, suggesting that when receiving a guideline, the patient is less likely to be referred. Therapeutic guidelines are important as first treatment option, because when solving the reason that led to the consultation, they prevent higher expenses for the system and loss of time on the part of the user.

Finally, the limitations of this study are the use of a secondary database; the inclusion of an older population, which may have increased the number of consultations for pain in these centers; the number of incomplete medical records; the destandardization of the filling in of medical records among the centers; and the varied definition as to the naming of the diagnosis. However, this study presents a pioneering character because shoulder pain is discreetly analyzed, especially in Brazil and in primary health care. Other studies need to uncover the issues of incidence, lifestyle, associated diseases, income, race, and psychosocial factors related to shoulder pain.

CONCLUSIONS

The predominant profile of individuals complaining of shoulder pain consisted of old-age, married and literate women who presented an occupation that did not necessarily demand the use of the upper extremity. The characteristics of the visits corroborate the principles of primary care: the consultations, in their most, had scheduled follow-up appointments, offering therapeutic guidance and few referrals.

ACKNOWLEDGEMENTS

We thank the Programa Institucional de Bolsas de Iniciação Científica (Pibic) for the financial support.

REFERÊNCIAS

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    Smith E, Hoy DG, Cross M, Vos T, Naghavi M, Buchbinder R, et al. The global burden of other musculoskeletal disorders: Estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(8):1462-9. doi: 10.1136/annrheumdis-2013-204680
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  • Finance source: CNPq
  • Approved by the Research Ethics Committee according to the Resolution of the National Health Council No. 466/2012: CAAE 40772214.9.0000.5414.

Publication Dates

  • Publication in this collection
    Jan-Mar 2019

History

  • Received
    21 May 2018
  • Accepted
    12 Dec 2018
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