Physiotherapy Treatment for Shoulder Pain – Research Evidence

• A systematic review of investigations into the diagnostic accuracy of clinical tests for rotator cuff pathology.
• Conclusions:
  • Overall, most tests for rotator cuff pathology were inaccurate and cannot be recommended for clinical use.
  • At best, suspicion of a rotator cuff tear may be heightened by a positive palpation, combined Hawkins/painful arc/infraspinatus test, Napoleon test, lift-off test, belly-press test, or drop-arm test, and it may be reduced by a negative palpation, empty can test or Hawkins-Kennedy test.

 Hegedus et al (2012)

• Systematic Review
• Based on data from the original 2008 review and this update, the use of any single shoulder physical exam test (ShPE) to make a pathoanatomic diagnosis cannot be unequivocally recommended. There exist some promising tests but their properties must be confirmed in more than one study. Combinations of ShPE tests provide better accuracy, but marginally so. These findings seem to provide support for stressing a comprehensive clinical examination including history and physical examination.
• However, there is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the many aspects of the clinical examination and what combinations of these aspects are useful in differentially diagnosing pathologies of the shoulder.

Wright et al (2012)

• Systematic Review regarding the diagnostic accuracy of physical examination tests for the scapula in patients with shoulder disorders.
• Overall, no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.

Braman et al (2013)

• “Impingement syndrome” is a common diagnostic label for patients presenting with shoulder pain. Historically, it was believed to be due to compression of the rotator cuff tendons beneath the acromion.
• It has become evident that “impingement syndrome” is not likely an isolated condition that can be easily diagnosed with clinical tests or most successfully treated surgically. Rather, it is likely a complex of conditions involving a combination of intrinsic and extrinsic factors.
• Therefore, it is advocated that the clinical diagnosis of “impingement syndrome” be eliminated as it is no more informative than the diagnosis of “anterior shoulder pain”. While both terms are ambiguous, the latter is less likely to presume an anatomical tissue pathology that may be difficult to isolate either with a clinical examination or with diagnostic imaging and may prevent potentially inappropriate surgical interventions.
• For shoulder researchers, we recommend investigations of homogenous patient groups with accurately defined specific pathologies, or with subgrouping or classification based on specific movement deviations.

• Conducted a study to investigate the effect of changing thoracic and scapular posture on shoulder flexion and scapular plane abduction range of motion in asymptomatic subjects, and in subjects with subacromial impingement syndrome.
• Results:
  • Changing posture:
    • Had an effect on all components of posture measured and these changes were associated with a significant increase  in the range of motion in shoulder flexion and abduction in the plane of the scapula.
    • Was not found to have a significant effect on the intensity of pain experienced by the symptomatic subjects, although the point in the range of shoulder elevation at which they experienced their pain was significantly higher.
• Conclusion:
  • The findings of this investigation suggest that changing 1 or more of the components of posture may have a positive effect on shoulder range of movement and the point at which pain is experienced.

• Systematic Review
• Aim:
  • To conduct a systematic review on manual and manipulative therapy (MMT) for common shoulder pain and disorders.
• Conclusions:
  • This study found a level of B or fair evidence for MMT of the shoulder, shoulder girdle, and/or the FKC combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction.
  • There is a fair or B level of evidence for MMT of the shoulder/shoulder girdle and FKC combined with a multimodal treatment approach for shouldercomplaints, dysfunction, disorders, and/or pain.

Kromer et al (2009)

• Systematic Review
• Aim:
  • To critically summarize the effectiveness of physiotherapy in patients presenting with clinical signs of shoulder impingement syndrome.
• Conclusions:
  • This review shows an equal effectiveness of physiotherapist-led exercises compared with surgery in the long term and of home-based exercises compared with combined physiotherapy interventions in patients with shoulder impingement syndrome in the short and long term; passive treatments cannot be recommended for shoulder impingement syndrome.
  • However, in general, the samples were small, and different diagnostic criteria were applied, which makes a firm conclusion difficult. More high-quality trials with longer follow-ups are recommended.

Hanratty et al (2012)

Maund et al (2012)