Margit Kooijman

Shoulder vignettes | 47 TABLE 4. Management of early presentation of adhesive capsulitis * (continued) * multiple responses possible; ** significant at p < 0.05 level; na = not applicable Vignette 4: Late presentation of adhesive capsulitis A large proportion of general practitioners indicated that further imaging and/or referral to an orthopaedic surgeon was necessary (table 5). Despite stiffness rather than pain was the main complaint in this chronic phase, more than half of them would administer a glucocorticoid injection or refer for one. About one third of physiotherapists indicated they would refer the patient to their general practitioner for one of these reasons. In total, 57% of general practitioners would refer for some type of physiotherapy and a minority indicated they would advise on home exercises or activity/work modification. Contrary, many physiotherapists considered this an important part of their treatment, next to mobilization techniques and exercise therapy. Both groups do not pay much attention to the psychosocial aspect of the complaints. Whilst most physiotherapists believed that recovery would take place within one to two years, general practitioners were divided on the prognosis. V3 General practitioners (n = 84) Physiotherapists (n = 110) P-value N (%) N (%) Referral Would not refer 31 (38) 28 (26) Orthopaedic surgeon 8 (10) na Physiotherapy – exercise therapy 29 (35) na Physiotherapy – mobilisation/massage 16 (20) na Physiotherapy – advice on activities of daily living, work, home exercises 13 (16) na Physiotherapy – not specified 9 (11) Colleague physiotherapist for ultrasound na 10 (9) GP – not specified na 13 (12) GP for pain medication na 50 (47) GP for investigations (e.g. MRI) na 17 (16) GP for referral to orthopaedic surgeon na 9 (8) Prognosis – likely or very likely to: Recover within 2 weeks 15 (18) 0 (0) ˂ 0.001 ** Recover within 6 weeks 43 (51) 15 (14) ˂ 0.001 ** Recover within 1-2 years 71 (85) 97 (88) 0.459 Have a recurrence within 2 years 8 (10) 6 (5) 0.278 Have permanent difficulties with activities of daily life 7 (8) 3 (3) 0.080 Require surgery 2 (2) 2 (2) 0.785