In this article, we will discuss shoulder pain and impingement.
Do you know that shoulder pain can be caused by impingement syndrome?
There are many causes of shoulder pain that need to be identified.
One of them is impingement syndrome, which is caused when a soft tissue collides with another soft tissue for some reason.It is not uncommon in clinical practice and we need to learn how to deal with it. There was a study that investigated this question.
Contents of the study
Subscapularis impingement syndrome (SIS) is a common cause of disability in approximately 74% of patients with shoulder pain (SP).
Although modern research has explained that SIS is not the cause of SP, it still seems to be one of the most controversial topics among scholars and clinicians.
From a clinical perspective, clinicians use both medical and physiotherapy approaches as effective ways to treat SIS.
This study aimed to investigate the management model of Italian physiotherapists and orthopedic surgeons for patients with SIS.
An online survey using a 29-item questionnaire was conducted to assess the knowledge of OMPT and orthopedic surgeons.
The role of diagnostic imaging in diagnostic procedures
Management with physical therapy
Pharmacological and surgical management of SIS patients.
We were able to complete the survey with 629 respondents.
511 OMPTs and 128 orthopedic surgeons
OMPT (92%) and orthopaedic surgeons (80.5%) stated that in patients with SIS, a combination of diagnostic tests improves diagnostic accuracy.
OMPT (27%) and orthopedic surgeons (4.7%) stated that the lift-off test was the most specific test.
OMPTs (83%) and 40 orthopedic surgeons (31.3%) said that what can be described as the standard method of diagnosis for SIS patients is history and clinical examination.
Differences between clinicians and physical therapists
Here are some of the differences that were found within the study.
Clinical examination
In terms of specificity in clinical tests, most OMPTs reported that the Empty can test had the highest specificity and the Neer sign had the lowest specificity.
Orthopedic surgeons reported the highest specificity for the Hawkins-Kennedy test and the lowest specificity for the lift-off test.
With regard to the diagnosis of SIS patients, the majority of OMPTs stated that the diagnosis should be reached by recording information from both the history and clinical examination.
However, orthopedic surgeons said they could make the diagnosis by clinical examination and imaging.
Treatment Strategies
Regarding the treatment plan for SIS patients, both OMPT and orthopedic surgeons said that the application of conservative therapy is the most useful.
How to view physical therapy
Among the conservative therapies, the most common response was that exercise therapy was perceived as the method most likely to restore function.
However, when it came to the goals of exercise therapy, the majority of OMPTs stated that patient education and reassurance were the primary goals, while the majority of orthopedic surgeons stated that pain relief was the primary goal.
In terms of what to look for in exercise therapy, OMPTs responded that exercise should not be targeted to specific structures.However, the orthopedic surgeon responded that exercise therapy should focus on scapular dyskinesia.
Regarding the practice of exercise therapy, the OMPT responded that exercise therapy performed on patients with SIS should be done only infrequently, and orthopedic surgeons responded that it should be done painlessly.
Brindisino F, Ristori D, Lorusso M, et al. Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities. Arch Physiother. 2020;10:16. Published 2020 Sep 2. doi:10.1186/s40945-020-00087-7
Conclusion
This is the end of the article about the difference in thinking between physical therapists and orthopedic surgeons in dealing with subacromial impingement syndrome.
Not all qualified people are like this, but the majority seemed to think that way.
Physical therapists tend to treat patients in a more patient-oriented way, while orthopedic surgeons tend to treat patients in a more biomechanical way.
I thought that something similar could be said in Japan, so I introduced it here.
Which one is preferable depends on the individual patient, but it is said that the approach of the physiotherapist in this study is what is desired as a policy of complementary medicine.
However, there are many clinical situations where I feel that many self-proclaimed "healers" tend to think more like the orthopedic surgeons in this study.
Even in seminars to make sales, the content tends to spread the orthopedic surgeon's way of thinking, which is the opposite of what this study has shown.
It is something that may require us to put our hands on our chests and reconsider.
