Evidence Based Interventions for Shoulder Pain
Original Editor - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Rachael Lowe, Kim Jackson, Rucha Gadgil, Robin Tacchetti, Lucinda hampton, Simisola Ajeyalemi and Haseeb Ur Rehman
Introduction[edit | edit source]
Types of Interventions[edit | edit source]
Education[edit | edit source]
Education plays a great role in the management of individuals with shoulder pain. The physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient and providing biomechanical information about the shoulder that is not evidence-based can add to their concerns. It is important to avoid reinforcing individuals fears about the threatening processes that might be going on as these fears or concerns can act as a barrier to recovery and need to be properly addressed.
An essential component of treatment for individuals with shoulder pain is to encourage active self-management. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. Advice can be effectively supported by offering simple evidence-based educational materials.
Exercise Therapy[edit | edit source]
There are few studies about the efficacy of conservative treatment. Even though current evidence is not sufficient to allow definitive conclusions on conservative treatment is commonly treated non-operatively with therapeutic exercise therapy. The results of randomized controlled trials and systematic reviews of interventions suggest that exercise may be an effective treatment, but there is a definite need for well-planned randomized controlled trials investigating the efficacy of exercise in the management in some conditions.
Although a structured exercise program is unequivocally the main intervention for Rotator Cuff related Shoulder Pain (Haahr and Andersen, 2006, Ketola et al.,2013, Kukkonen et al., 2014) consensus on dosage, frequency, method of delivery, acceptable pain tolerance, inter-exercise activity levels, and specific exercise inclusion has not been achieved. Systematic reviews investigating exercise for RCRSP have produced varied findings.[1][2][3][4]
Level 2 - Confidence A
- Effective in terms of short term recovery in rotator cuff disease (RR 7.74 (1.97, 30.32), and longer term benefit with respect to function (RR 2.45 (1.24, 4.86). – Green, S; Buchbinder, R; Hetrick, S , Cochrane Review, updated Feb. 2009
- Effective for pain reduction and function restoration in impingement (11 trials)
- – Kuhn JE. JSES 2009
Passive Treatments[edit | edit source]
Manual Therapy[edit | edit source]
Level 2 - Confidence B
- Benefits appear to be mostly short term and about the same as injection – Green, S; Buchbinder, R; Hetrick, S , Cochrane Review, updated Feb. 2009
- High Grade better than low grade in the long-term, end-range and MWM better than mid-range, and Mob + exer better than exer alone – MM Favejee et al. Br J Sports med 2011. Review
- For manual therapy in general with common shoulder disorders (excluding neurogenic disorders) – JW Brantingham et al. JMPT 2011. Review
Taping[edit | edit source]
Kinesiotape[edit | edit source]
Level 2 - Confidence D
• Thelen et al. JOSPT 2008 - KT vs. Sham in 42 subjects - Didn’t help impingement pain
• Hsu et al. J Electromyo Kinesiol
– 17 baseballers with impingement pain
– Increased post scap tilt @ 30 & 60 elevation AND increase lower trap activity in the 60-30 lowering range
Electrotherapy Modalities[edit | edit source]
Low Level Laser[edit | edit source]
Level 2 - Confidence B
• Short term (2 Week Benefit) vs. Placebo RR 3.71 (1.89-7.28)
• Green S et al. Cochrane Reviews 2009
Resources[edit | edit source]
References[edit | edit source]
- ↑ Haahr JP, Andersen JH. Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study. Scand J Rheumatol. 2006;35:224-8.
- ↑ Ketola S, Lehtinen J, Rousi T, Nissinen M, Huhtala H, Konttinen YT, et al. No evidence of long-term benefits of arthroscopicacromioplasty in the treatment of shoulder impingement syndrome: Five- year results of a randomised controlled trial. Bone & joint research. 2013;2:132-9.
- ↑ Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, et al. Treatment of non- traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. The bone & joint journal. 2014;96-B:75-81.
- ↑ Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Manual therapy. 2016 Jun 1;23:57-68.
