What specialist should a patient with left shoulder pain and radiographic evidence of orthopedic anchors, arthritic changes, and post-operative changes be referred to: a pain management specialist or an orthopedic (orthopedic) specialist?

From the Guidelines

For a patient with left shoulder pain and X-ray findings showing orthopedic anchors, arthritic changes, and post-operative changes, referral to an orthopedic specialist is the most appropriate initial step. The orthopedic surgeon who performed the original procedure would be ideal, as they are familiar with the patient's surgical history and can properly evaluate the hardware they placed 1. Orthopedic specialists are specifically trained to manage both the mechanical issues related to the anchors and the arthritic changes present in the joint. They can determine if the pain is related to hardware complications, progression of arthritis, or incomplete healing from the previous surgery. Some key points to consider in this decision include:

• The presence of orthopedic anchors indicates previous surgical intervention, making orthopedic follow-up the logical first step in addressing the current symptoms.
• Orthopedic specialists can evaluate the patient's symptoms in the context of their surgical history and the presence of arthritic changes, allowing for a comprehensive assessment of the patient's condition.
• While pain management specialists are valuable for chronic pain conditions, this presentation suggests a potential surgical or mechanical issue that should first be evaluated by an orthopedist who can then refer to pain management if needed after ruling out problems requiring surgical intervention 1. Key considerations for the orthopedic specialist include:
• Evaluating the hardware components, alignment, and surrounding osseous and soft-tissue structures to determine the cause of the patient's pain.
• Assessing the patient's range of motion, strength, and overall functional ability to determine the impact of the pain on their daily activities.
• Developing a treatment plan that addresses the patient's specific needs, which may include further imaging, physical therapy, or surgical intervention.

From the Research

Diagnosis and Referral

• The patient's left shoulder pain, along with the presence of orthopedic anchors, arthritic changes, and post-operative changes on the X-ray, suggests a complex condition that requires careful evaluation and management 2, 3, 4.
• The diagnosis of shoulder pain involves a thorough physical examination, patient history, and correlation with imaging signs 4, 5.
• Given the patient's history of post-operative changes, it is essential to consider the possibility of complications or residual symptoms from previous surgeries 6.

Treatment Options

• Conservative treatment options for shoulder pain, including physical therapy, pharmacological therapy, and biological therapy, may be effective in managing the patient's symptoms 2.
• Pain management specialists may be involved in the patient's care to address chronic pain and inflammation 2, 4.
• Orthopedic specialists may also be necessary to evaluate and manage any underlying structural issues or complications from previous surgeries 3, 6.

Referral Decision

• Considering the complexity of the patient's condition, it may be beneficial to refer the patient to both a pain management specialist and an orthopedic specialist for a comprehensive evaluation and management plan 2, 3, 4, 6.
• The patient's specific needs and symptoms should guide the referral decision, with the goal of providing optimal care and improving functional outcomes 2, 6.