Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 May 30:8:7.
doi: 10.1186/s40945-018-0050-3. eCollection 2018.

Towards an integrated clinical framework for patient with shoulder pain

Diego Ristori  1   2 , Simone Miele  3   2 , Giacomo Rossettini  4   2 , Erica Monaldi  5   2 , Diego Arceri  6   2 , Marco Testa  7   2
Affiliations
Review

Towards an integrated clinical framework for patient with shoulder pain

Diego Ristori et al. Arch Physiother. .

Abstract

Background: Shoulder 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.

Objectives: The 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.

Conclusion: The 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.

Keywords: Clinical framework; Diagnosis; Rehabilitation treatment; Shoulder pain.

PubMed Disclaimer

Conflict of interest statement

Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Inconsistency of diagnostic labels in SP. The weak correlation between structural factors and shoulder pain, together with the limited diagnostic value of bio-imaging and clinical tests, caused a lack of uniformity in diagnostic labelling
Fig. 2
Fig. 2
The integrated clinical model for the assessment and treatment of SP. By history taking, the physiotherapist investigates pain characteristics, its prevalent mechanisms and patient’s beliefs and expectations. Integrating this information with the results of the physical assessment, the physiotherapist classifies the shoulder pain condition with three diagnostic labels: Red Flags and Specific SP which require a referral to a specialist consultation and Non-specific SP which falls within the competence of the physiotherapist
Fig. 3
Fig. 3
Non-specific SP: the algorithm of treatment. De-sensitization procedures should be adopted first. If an improvement of pain and/or patient’s satisfaction is obtained, the treatment load should be increased by using the positive procedures and specific exercises. If this first approach does not reach its goal, then therapeutic strategies based on the prevalent pain mechanism should be implemented. Symptom-contingent strategy or manual techniques (in cases of joint stiffness) and time-contingent strategy have to be used in patients respectively with prevalent NP or CS mechanisms. In case of lack of improvement, the patient should be re-assessed or referred to the specialist
See this image and copyright information in PMC

References

    1. Kuijpers T, Van Tulder MW, Van der Heijden GJ, Bouter LM, Van der Windt DA. Costs of shoulder pain in primary care consulters: a prospective cohort study in the Netherlands. BMC Musculoskelet Disord. 2006;7:83. doi: 10.1186/1471-2474-7-83. - DOI - PMC - PubMed
    1. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JA. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73–81. doi: 10.1080/03009740310004667. - DOI - PubMed
    1. Parsons S, Breen A, Foster NE, Letley L, Pincus T, Vogel S, Underwood M. Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations. Fam Pract. 2007;24:308–316. doi: 10.1093/fampra/cmm027. - DOI - PubMed
    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287–333. doi: 10.1016/j.ejpain.2005.06.009. - DOI - PubMed
    1. Magee D. Orthopedic physical assessment. 6. Edmonton: Elsevier; 2013.

LinkOut - more resources