Management of shoulder pain in primary care
Shoulder pain is the third most common musculoskeletal complaint and especially rotator cuff diseases are a frequently reported problem. But, although shoulder pain is commonly presented in primary care, the information on characteristics of physical examination and treatment in physiotherapy practice is lacking. Thus, this study aimed to gain insight into current physiotherapeutic management concepts.
In total 125 physiotherapists from the South West region of the Netherlands participated in this prospective cohort study and recruited 389 patients. Data was collected from PTs and the patients using digital questionnaires. Patient- and clinical characteristics were measured, and patients received follow-up questionnaires after 6 and 12 weeks concerning recovery.
After the anamnesis, the most suspected (48%) hypothesis was subacromial impingement, followed by pain due to cervical or thoracic dysfunctions (14%).
The most commonly applied tests during the physical examination for a suspected impingement were: Neer's sign (73%), Hawkins-Kennedy Test (80%), Empty/ Full Can (85%) and the painful arc (64%). and for a suspected glenohumeral instability: O’Brien's (46%), the Relocation Test (70%), the Appprehension test and the Sulcus sign. Most physiotherapists formulated multiple hypotheses and used several tests in their physical examination.
Although diagnostic ultrasound is expected to lead to a more specific clinical diagnosis, it was only used in 31% of all participants with shoulder complaints. However, the effect of ultrasound on patient recovery remains unknown.
During the baseline treatment programme especially advices (91%), exercise therapy (81%) and mobilisation were most commonly applied. Rather alarming was that 73% of patients with subacromial impingement, who had no or insufficient improvement, still received treatment after 6-12 weeks. And only 60% of patients were recovered after 26 weeks. This means that most patients were not treated according to recommendations from the evidence statement, that requires a referral to the GP when no improvement is seen after 6-12 weeks of physiotherapy.
> From: Karel et al., Physiotherapy (2017) (Epub ahead of print). All rights reserved to Elsevier Ltd. Click here for the online summary.