Abstract
Objetivo
Describir el tipo de población que consulta por hombro doloroso en atención primaria en Asturias. Describir la exploración, el diagnóstico, los tratamientos utilizados y la respuesta clínica.
Diseño
Estudio descriptivo, longitudinal.
Emplazamiento
Centros de salud docentes del Área V de Asturias.
Participantes
Pacientes que consultaron por dolor de hombro en octubre y noviembre de 2002.
Mediciones principales
Características de los pacientes: edad, sexo, profesión, baja laboral, arco doloroso, flexión, rotación internaexterna e impresión diagnóstica. A los 5 meses se registraron los datos sobre su evolución, radiografías, ecografías, fármacos, infiltraciones, fisioterapia, ejercicios en el domicilio, derivación especializada y diagnóstico final.
Resultados
Se recogieron 110 casos (58,2%, mujeres y 41,8%, varones), con una media de edad de 57 años (intervalo de confianza [IC] del 95%, 54,17-59,79). El 52,7% estaba jubilado. El 7,3% se encontraba en situación de baja laboral. En un 30% no se disponía de la exploración de ningún arco de movimiento. El 70% de los pacientes evolucionó satisfactoriamente. El diagnóstico más frecuente fue la tendinitis de manguito, y la concordancia entre los diagnósticos inicial y final fue buena. Un 77,4% tomó antiinflamatorios no esteroideos (AINE). El 16% recibió infiltraciones.Un 32,1% realizó fisioterapia y un 36,8%, ejercicios en el domicilio. En el 65,1% de los pacientes no se hizo ninguna radiografía y sólo se efectuó una ecografía en el 6,6%. La evolución favorable no se asoció estadísticamente con los fármacos o la infiltración, y sí con la fisioterapia y los ejercicios.
Conclusiones
La mayoría de pacientes con hombro doloroso son mujeres, de mediana edad y pensionistas. Más del 60% evoluciona satisfactoriamente. La exploración realizada suele ser incompleta y con pocas pruebas complementarias.
Palabras clave: Hombro doloroso, Evolución, Pacientes
Abstract
Objectives
To describe the population attending teaching health centres in Area V, Asturias, to consult for painful shoulder. To describe the examination, diagnosis, treatment and clinical response.
Design
Longitudinal, descriptive study.
Setting
Teaching health centres in Area V, Asturias.
Participants
Patients consulting because of pain in their shoulders in October and November 2002.
Main measurements
Two measurements, the first of which in December 2002 appraised age, sex, job, time off work, arc of pain, flection, internal-external rotation, and diagnostic impression. The second, in May 2003, assessed evolution, x-rays, echography, medication, infiltration, physiotherapy, exercises at home, referral to specialist, and final diagnosis. Bivariant and kappa index descriptive analyses were run.
Results
110 cases, 58.2% women and 41.8% men, with an average age of 57 (95% CI, 54.17-59.79), were included. 52.7% were retired; no particular job predominated; 7.3% were off work; 30% had had no examination of arc of movement; 70% evolved satisfactorily. The most common diagnosis was cuff tendinitis, with initial and final diagnosis coinciding well. 77.4% of patients took NSAIDs; 16% were infiltrated; 32.1% did physiotherapy; and 36.8%, exercises at home. 65.1% had no x-ray and only 6.6% had echographies, all of which found something. There was no statistically significant relationship between medication or infiltration and favourable evolution; and there was, between physiotherapy or exercises and favourable evolution.
Conclusions
Most patients were middle-aged, women, pensioners, and had little time off work. Two-thirds evolved well. Examinations were incomplete and few complementary tests were run.
Key words: Painful shoulder, Evolution, Patients
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