Evidence Based Interventions for Shoulder Pain
Original Editor - Naomi O'Reilly
Top Contributors - Naomi O'Reilly, Rachael Lowe, Kim Jackson, Rucha Gadgil, Robin Tacchetti, Simisola Ajeyalemi, Haseeb Ur Rehman and Lucinda hampton
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 varied findings but do suggest that exercise may be an effective treatment for overall shoulder pain, and a structured exercise program is unequivocally the main intervention specifically for Rotator Cuff related Shoulder Pain, while consensus on dosage, frequency, method of delivery, acceptable pain tolerance, inter-exercise activity levels, and specific exercise inclusion has not been achieved.[1][2][3][4] There is a definite need for well-planned randomized controlled trials investigating the efficacy of exercise in the management in specific shoulder conditions.
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) [5]
Passive Treatments[edit | edit source]
Manual Therapy[edit | edit source]
Evidence suggests that manual therapy is beneficial for at least some patients with shoulder pain but there is no evidence for manual therapy techniques as a stand alone treatment option. Evidence suggests that manual therapy is more effective when used in combination with exercise.
Level 2 - Confidence B
- Benefits appear to be mostly short term and about the same as injection[6]
- High Grade better than Long Grade in the long-term, End-range and MWM better than Mid-range[7]
- Mobilisation plus Exercise better than Exercise alone, but only at the shortest follow-up[7]
- For manual therapy in general with common shoulder disorders, excluding neurogenic disorders [8]
Taping[edit | edit source]
Kinesiotape[edit | edit source]
Level 2 - Confidence D
- Kinesio Tape vs. Sham in 42 subjects - Did not help impingement pain [9]
- 17 baseballers with impingement pain - Increased post scap tilt @ 30 & 60 elevation AND increase lower trap activity in the 60-30 lowering range [10]
Electrotherapy Modalities[edit | edit source]
Low Level Laser[edit | edit source]
While Low Level Laser does not appear to have strong evidence as a stand alone treatment, there is evidence to suggest that Low Level Laser reduces pain is and is a viable pain-modifying treatment. Consequently Low Level Laser may accelerate improvement of physical function, possibly by controlling inflammation or stimulating tendon repair, with the end result being reduced pain and more rapid improvement when added to an exercise-based treatment programme or in a physiotherapy treatment regimen and is suggested that Low Level Laser may have a more pronounced effect on shoulder function if the benefit of pain relief is used specifically to optimize parameters of exercise. [11]
Research suggests that Low Level Laser treatment is a safe and effective pain treatment option in comparison to Corticosteroid Injection, particularly for Rotator Cuff Tendinopathy, and as such should be offered before proceeding with Injection Therapy but further high quality trials are required where the effect of laser is directly compared with pharmaceuticals. [6][11]
Level 2 - Confidence B
- Low Level Laser to Placebo showed significantly better shoulder function at end of treatment (p < 0.0001) [11]
- Low Level Laser Superior to Sham Low Level Laser
- Short term (2 Week Benefit) vs. Placebo RR 3.71 (1.89-7.28) [6]
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.
- ↑ Kuhn, John E. "Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol." Journal of shoulder and elbow surgery 18.1 (2009): 138-160.
- ↑ 6.0 6.1 6.2 Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database systematic Review The Cochrane library. 2006;3.
- ↑ 7.0 7.1 Favejee, M. M., B. M. A. Huisstede, and B. W. Koes. "Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review." British journal of sports medicine 45.1 (2011): 49-56.
- ↑ Brantingham, James W., et al. "Manipulative therapy for shoulder pain and disorders: expansion of a systematic review." Journal of manipulative and physiological therapeutics 34.5 (2011): 314- 346.
- ↑ Thelen, Mark D., James A. Dauber, and Paul D. Stoneman. "The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial." journal of orthopaedic & sports physical therapy 38.7 (2008): 389-395.
- ↑ Hsu, Yin-Hsin, et al. "The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome." Journal of electromyography and kinesiology 19.6 (2009): 1092-1099.
- ↑ 11.0 11.1 11.2 Haslerud S, Magnussen LH, Joensen J, Lopes‐Martins RA, Bjordal JM. The efficacy of low‐level laser therapy for shoulder tendinopathy: a systematic review and meta‐analysis of randomized controlled trials. Physiotherapy Research International. 2015 Jun 1;20(2):108-25.
