Margit Kooijman

General Introduction | 13 A 42-year-old man presents with shoulder complaints in the local physiotherapy practice. He was referred by the general practitioner for recurrent complaints; a corticosteroid injection had had no effect. He has been having complaints for about six months but cannot remember a clear cause. The pain intensity varies; sometimes it is almost gone and other times it keeps him from sleeping properly. He also noticed that his posture is slightly bent. Many times he has been on the point of visiting a general practitioner or a physiotherapist but as many times he didn’t think his pain and limitations in function severe enough. Recently though, the pain increased and prevents him not only from sleeping but also from playing tennis. In addition, dressing himself and doing groceries is becoming problematic. Now, he is worried that it will deteriorate so he seeks advice if it is maybe best to wear a sling for a while or that he should ignore the pain and keep on going? It is becoming increasingly clear that pain is one of our most common and expensive public health problems and the leading cause of disability worldwide 12,3, . In a population-based survey, nearly three-quarter of the Dutch population reported the presence of musculoskeletal pain during the past 12 months 4 . Around half of them had contacted a health professional because of it; meaning that on a yearly basis, 28% of the general population consulted a health care professional because of musculoskeletal pain. These professionals mainly involve general practitioners, physiotherapists and medical specialists such as orthopaedic surgeons. This survey as well as recent figures from the global burden of disease study revealed that musculoskeletal pain was very prevalent in younger age groups and not an aging problem as such 3,4 . Yet, besides being a burden for the individual, musculoskeletal pain represents a burden on the society that is expected to increase because people tend to live longer 2 . Shoulder pain is amongst the most frequently reported pain sites 5,6 . Prevalence and burden of shoulder pain In 2006, a systematic review of the literature revealed that the point prevalence for upper extremity musculoskeletal disorders differed from 2-53% and the 12-month prevalence from 2-41%, depending on the setting and definition used 7 . In the Netherlands, the 12-month prevalence of (non-traumatic and non-systemic) complaints of the arm, neck and/or shoulder (CANS) in the open population was 37% and the point prevalence was 26% 8 . The prevalence figures for shoulder pain specifically ranged from 7-26% for point prevalence and 5-47% for the 12-month prevalence 9 . In Norway, the one-year prevalence of shoulder pain in the general population was reported to be as high as 55% 10 . Besides upper extremity musculoskeletal disorders can adversely affect daily living, they are associated with a high economic and social burden. They are responsible for substantial health care resource expenditure, work absenteeism and disability. In the