Towards an integrated clinical framework for patient with shoulder pain

Abstract

BackgroundShoulder pain (SP) represents a common musculoskeletal condition that requires physical therapy care. Along the years, the usual evaluation strategies based on clinical tests and diagnostic imaging has been challenged. Clinical tests appear unable to clearly identify the structures that generated pain and interpretation of diagnostic imaging is still controversial. The current patho-anatomical diagnostic categories have demonstrated poor reliability and seem inadequate for the SP treatment.ObjectivesThe present paper aims to (1) describe the different proposals of clinical approach to SP currently available in the literature; to (2) integrate these proposals in a single framework in order to help the management of SP.ConclusionThe proposed clinical framework, based on a bio-psychosocial vision of health, integrates symptoms characteristics, pain mechanisms and expectations, preferences and psychosocial factors of patients that may guide physiotherapist to make a diagnostic triage and to choose the right treatment for the individual patient.

Patients with subacromial pain in primary care : Assessment and efficacy of physiotherapy-guided exercise treatment

“…This method was chosen since it is difficult to isolate specific rotator cuff muscle activity in specific joint actions 125 , and because muscle force is an unreliable measure when pain is present 38,141 . This pragmatic approach gave a categorization based on the patient's shoulder function, rather than a structural diagnosis, which is in line with suggested methods by other researchers 90,126,133 and it is considered appropriate to differentiate patients with subacromial pain. This manner of categorization also allowed symptoms of different severity within each component, which confirms its eligibility.…”

Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities

“…In accordance with evidence-based practice [16,60], OMPTs attribute more value to the clinical examination and to the anamnesis in patients with SIS. Moreover, OMPTs were aware of the limitations of clinical tests and the valuable role that anamnesis and history provide in evaluating patients with SIS.…”

Importance of screening in physical therapy: vertebral fracture of thoracolumbar junction in a recreational runner

“…In this case report, various elements of the patient’s history have been collected (ie, trauma, pain intensity, numbness of the lower limbs, supine positive sign) and included in the clinical reasoning process to guide the consequent physical examination 72. Physical therapists must ask themselves questions through self-reflection during assessment and treatment to identify the presence/absence of risk factors 73…”