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Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice

¹ Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
² Netherlands Expert Center for Work-Related Musculoskeletal Disorders, Erasmus Medical Centre, Rotterdam, The Netherlands
³ Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
⁴ Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands

CORRESPONDING AUTHOR: Anita Feleus, PhD, Department of General Practice, Room Wk121 Erasmus Medical Center Rotterdam PO Box 2040 3000 CA Rotterdam, The Netherlands, a.feleus{at}erasmusmc.nl

OBJECTIVE We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician.

METHODS We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care.

RESULTS Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently.

CONCLUSIONS Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.

Key Words: Primary health care • upper extremity • arm • neck • shoulder • patient care management

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