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Managing Shoulder Pain in the Clinic: What to Look for and When to Intervene

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Course Description

This CME activity is a refresher on relevant functional musculoskeletal anatomy and physical exam techniques of the shoulder. Using case examples as well as didactics, animated visualizations, and video demonstrations, this course is designed to elevate the practicing physician’s confidence in understanding the current evidence base in managing routinely encountered conditions of the shoulder. Specific indications and timing for intervention and practices including various injection techniques are highlighted. In addition to providing a solid foundation in both physical exam and interventional skills, the curriculum is intended to introduce the physician to the role of ultrasound as a diagnostic and therapeutic tool in assessing shoulder conditions.

Intended Audience

This course is designed for primary care physicians including family practice and internal medicine physicians, neurologists, rheumatologists, and emergency medicine physicians.

Dates, Duration and Fee

  • Release Date: October 2, 2015
  • Expiration Date: August 31, 2017
  • Estimated Time to Complete: 2 Hours
  • CME Credits Offered: 2.00
  • Registration Fee: FREE

To Obtain CME Credits

  • Review the information below and complete the entire activity.
  • Complete the CME Post-test, CME Assessment Survey, and CME Activity Completion Statement at the end of the activity.
  • You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have two attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
  • Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

Learning Objectives

At the conclusion of this activity, participants should be able to:

  • Describe relevant functional musculoskeletal anatomy and biomechanics as they relate to routinely encountered conditions of the shoulder.
  • Conduct a standardized physical examination to efficiently assess the shoulder and help generate an accurate differential diagnosis.
  • Identify indications for immediate, urgent, or early referral to the appropriate sub-specialist.
  • Formulate appropriate management strategies for various shoulder conditions based on current evidence, including the indications, timing and methods of performing targeted shoulder injections.

Table of Contents

  1. Introduction
  2. Module 1. Introduction to Shoulder Anatomy and Pain
  3. Module 2. Comprehensive Physical Exam of Shoulder
  4. Module 3. Indications for Referrals
  5. Module 4. Conservative Management of Shoulder Pain
  6. Course Wrap-up
  7. Resources and References
  8. Help!

Disclosures

The following planners, speakers and authors have indicated that they have no relationships with industry to disclose relative to the content of this activity:

Eugene Yousik Roh, MD

Clinical Assistant Professor of Orthopedic Surgery
Stanford University School of Medicine
Course Director
Author/Speaker

Ninad Karandikar, MD

Assistant Professor (Affiliated) of Orthopedic Surgery
Stanford University School of Medicine
Medical Director, Regional Amputation and Transitional Rehabilitation Program
Veterans Administration, Palo Alto Health Care System
Course Director
Author/Speaker

Rebecca Dutton, MD

Chief Resident
Stanford University School of Medicine
Planner
Author/Speaker

YT Chen, MD

Sports Medicine Fellow
Stanford University School of Medicine
Planner
Reviewer

Technical Design and Development

Mike McAuliffe
Stanford EdTech

Kimberly Walker, PhD
Stanford EdTech

Greg Bruhns
Stanford Online

Derek Yee
Role Play Actor
 

Hardware/Software Requirements

  • Computer with Internet connection
  • Current version of Chrome, Firefox or Safari browser
  • You must have javascript enabled

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 2.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support Acknowledgement

This activity received no commercial support.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.

You are encouraged to visit the portal: http://lane.stanford.edu/portals/cultural.html

CME Privacy Policy

CONTACT INFORMATION

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu.

Bibliography

Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: a systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1-42-1049.

American Academy of Orthopaedic Surgeons (AAOS). Clinical practice guideline on optimizing the management of rotator cuff problems. Rosemont (IL): American Academy of Orthopaedic Surgeons; 2010.

Comer GC, Liang E, Bishop JA. Lack of proficiency in musculoskeletal medicine among emergency medicine physicians. Journal of Orthop Trauma. 2014; 28(4): e85-e87

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DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. Journal of Bone and Joint Surgery. 2003; 85-A(3): 565-567.

Dragoo JL, Braun HJ, Kim HJ, Phan HD, Golish SR. The in vitro chondrotoxicity of single-dose local anesthetics. Am J Sports Med. 2012 Apr;40(4):794-9.

Hermans J, Luime JJ, Meuffels DE, et al. Does this patient with shoulder pain have rotator cuff disease?: the Rational Clinical Examination systematic review. JAMA. 2013;310(8):837-847.

Karandikar O, Ortiz O. Kinetic chains: a review of the concept and its clinical applications. PM&R. 2011; 3(8): 739-745.

Lynch JR, Schmale GA, Schaad DC, Loepold SS. Important demographic variables impact the musculoskeletal knowledge and confidence of academic primary care physicians. The Journal of Bone and Joint Surgery. 2006; 88(7): 1589-1595.

Malanga GA, Nadler S. Musculoskeletal Physical Examination: An Evidence-Based Approach. Philadelphia: Elsevier Health Sciences, 2006.

Matheney JM, Brinker MR, Elliott MN, Blake R, Rowane M. Confidence of graduating family practice residents in their management of musculoskeletal conditions. The American Journal of Orthopedics. 2000; 29(12): 945-952.

New Zealand Guidelines Group. The diagnosis and management of soft tissue shoulder injuries and related disorders. Wellington: ACC, July 2004.

Pedowitz RA, Yamaguchi K, Ahmad CS. American Academy of Orthopaedic Surgeons. Optimizing the management of rotator cuff problems. J Am Acad Orthop Surg. 2011;19(6):368-79.

Piper SL, Kramer JD, Kim HT, Feeley BT. Effects of local anesthetics on articular cartilage. Am J Sports Med. 2011;39(10):2245-53.

Soh E, Li W, Ong KO, Chen W, Bautista D. Image-guided versus blind corticosteroid injections in adults with shoulder pain: a systematic review. BMC Musculoskelet Disord. 2011 Jun 25;12:137.

Woolf AD, Pfledger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81(9): 646-656.

 


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