Shoulder Pain

Shoulder pain Case Study

32 year old breast feeding GP registrar was referred to Occupational Health with a 3-week history of insidious onset of bilateral shoulder pain, worse on the right side. She had recently returned to work after maternity leave.

The symptoms gradually worsened. In particular, she had difficulty in reaching upwards to high cupboards or holding her baby in the air. Driving was uncomfortable and it was really sore at night. She had visited her GP who advised analgesia and one week sickness absence – though the doctor did continue to work.

The doctor was then referred to occupational health by her manager.

She was triaged to the in-house Physiotherapy service and was seen within 1 week.

Following a screen of RED and YELLOW (psychosocial) flags and a full examination of her shoulder and upper limbs – it was identified that the patient’s symptoms were likely due to long head of biceps tendinopathy (an overuse injury).

Her symptoms were prominent during work days but the doctor was unable to give specific details about aggravating activities. She complained of fatigue at work linked to broken sleep. Following a detailed task analysis by the physiotherapist, it was ascertained that the likely cause was prolonged and repetitive carrying of her new baby at home, rather than work activities. However, in addition, driving and carrying a heavy doctor’s bag on home visits was aggravating the problem.

The Physiotherapist recommended specific exercises and sent a management report to the referring practice manager, providing advice on reasonable short term adjustments, likely prognosis and length of time expected before a return to full duties. Within 2 weeks the doctor’s symptoms were largely resolved, and she was able to return to her full duties without taking any time of work.

Key point from case study:

• Early referral to physiotherapy is important if musculo-skeletal symptoms are not improving and if they are beginning to impact on work duties.
• Multidisciplinary team working is important in managing work related musculoskeletal disorders.
• It is important to carry out a holistic assessment using the bio-psycho-social model.
• Specialist Occupational Health Practitioners can play a significant role in reducing sickness absence.
• Communication with managers is important throughout the patient’s treatment (providing consent is gained prior to communication). Practical advice on workplace adjustments may assist in supporting a doctor to remain in work, despite the presence of symptoms.