In early May 2003, a small group of four, including three family physicians and a media person, visited various family medicine education and training facilities in Edmonton, Alberta, Canada. This paper is a brief discussion of what knowledge and insight was gained during this trip.
Shoulder is one of the most common sites of pain in outpatient clinic, and allows for almost unrestrained motion in all planes due to very unique anatomical structure. Detailed history taking and special physical examination based on basic anatomical and kinesiological knowledge are important for precise patient evaluation. Further radiographic and diagnostic laboratory test are required. Common causes of shoulder pain are adhesive capsulitis, impingement syndrome, rotator cuff tear, myofascial pain syndrome, and instability. Also cervical radiculopathy, lung, cardiac and abdominal problems should be considered as a cause of shoulder pain. Characteristics, physical examination tool, and treatment for common shoulder problems are described.
Chronic pain is a self-sustaining, self-reinforcing, and self- regenerating process. It persists beyond 3∼6 months regardless of initial diagnostic category. It is not a symptom of an underlying acute somatic injury but rather, a destructive illness in its own right. It is an illness of the whole person and not a disease caused by the pathological state of an organ system. Chronic pain is persistent, long-lived, and progressive. Pain perception is markedly enhanced. Pain related behaviour becomes maladaptive and grossly disproportional to any underlying noxious stimulus, which usually has healed and no longer serves as an underlying pain generator. The purpose of this paper to present an approach to the prevention of chronic pain and disability, and to provide the clinician with potentially useful tools for the recognition of individuals at risk for chronic illness for whom multidisciplinary treatment is indicated.
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