Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 5 Issue 8

Guideline ‘Nonspecific Complaints of Arm, Neck and/or Shoulder (CANS)

Harald S Miedema 1,2* and Anita Feleus1

1Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
2Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands

*Corresponding Author: Harald S Miedema, Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.

Received: June 27, 2022; Published: July 15, 2022

  1. Complaints of the arm, neck and/or shoulder (CANS) are an important health problem. In the Netherlands, in any previous year about 33% of all adults reported to have CANS and more than 25% had CANS at the moment of inquiry. In addition, more than 10% of days lost to sickness absence is attributed to CANS.
  2. End 2012, a multidisciplinary guideline was published with recommendations for the diagnosis, treatment, care, and (work) participation of patients with nonspecific CANS. The purpose of this guideline is to improve the process of care and the multidisciplinary cooperation required, as well as to improve the communication with patients.
  3. The project started with a revision of the existing CANS model (dating from 2004). During this update, the list of disorders was extended to cover 36 specific diagnostic categories. In addition, a clinical pathway was developed that focuses on optimal timing of diagnostics and treatment, and on the multidisciplinary cooperation.
  4. The improved diagnostic process means that patients with specific CANS receive faster and better targeted treatment. Also, better understanding of treatment results leads to the choice of more effective treatments for patients with nonspecific CANS, so that more patients receive the most beneficial form of treatment.

Keywords:Guideline; Neck complaints; Shoulder complaints; Upper extremity complaints; Complaints of arm, neck and shoulder (CANS); Non-specific; Diagnosis and treatment


  1. Klein Hesselink J., et al. “Ziekteverzuim in Nederland 2009”. Hoofddorp: TNO (2011).
  2. Feleus A., et al. “Incidence of non-traumatic complaints of arm, neck and shoulder in general practice”. Manual Therapy 13 (2008): 426-433.
  3. The Hague: Gezondheidsraad (2000).
  4. Multidisciplinaire richtlijn ‘Aspecifieke klachten arm, nek en/of schouders’. Amersfoort: KNGF (2012).


Citation: Harald S Miedema and Anita Feleus. “Guideline ‘Nonspecific Complaints of Arm, Neck and/or Shoulder (CANS)". Acta Scientific Orthopaedics 5.8 (2022): 56-64.


Copyright: © 2022 Harald S Miedema and Anita Feleus. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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