87. Putting Special Tests for Rotator Cuff-Related Shoulder Pain out to Pasture w/ Paul Salamh
Mar 14, 2023
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Paul Salamh, shoulder/upper extremity specialist, joins the podcast to discuss putting special tests for rotator cuff-related shoulder pain out to pasture. The topics covered include common shoulder special tests, imaging findings, pre and post test probabilities, limitations of gold standards, the importance of a comprehensive interview, and Paul's current research on frozen shoulder and pitcher fatigue.
Special tests for rotator cuff-related shoulder pain lack convergent validity with gold standards like MRI.
The correlation between imaging findings and pain/function challenges the assumption that special tests isolate specific structures.
A comprehensive examination, including a patient interview, screening for red flags, and shared decision-making, is crucial when examining rotator cuff-related shoulder pain.
Deep dives
The podcast explores the limitations of special tests for rotator cuff-related shoulder pain
The podcast episode discusses the viewpoint titled 'It is time to put special tests for rotator cuff-related shoulder pain out to pasture' by Paul Slom and Jeremy Lewis. The episode delves into the decision to write the piece, the most common shoulder special tests, the validity of special tests, and the correlation between imaging findings and pain/function. It also examines the recommended examination elements for rotator cuff-related shoulder pain and delves into the research project involving frozen shoulder.
Special tests for rotator cuff-related shoulder pain lack convergent validity and have limitations
The podcast highlights the lack of convergent validity in special tests for rotator cuff-related shoulder pain. Special tests are compared to gold standards, such as MRI, but this approach may not accurately reflect an individual's symptoms and pain. The episode emphasizes that a rotator cuff tear may not always be painful, and individuals without tears may experience pain. The correlation between imaging findings and pain/function is explored, challenging the assumption that special tests can isolate specific structures.
Likelihood ratios and pre/post-test probabilities are questioned for special tests
The podcast episode discusses the limitations of likelihood ratios and pre/post-test probabilities for special tests. It highlights that these metrics rely on comparing special tests to gold standards, which may not accurately reflect an individual's symptoms. The episode emphasizes the importance of considering individual pain, function, and impairments through a comprehensive examination, rather than relying solely on special tests.
The recommended approach for examining rotator cuff-related shoulder pain
The podcast episode outlines the recommended approach for examining rotator cuff-related shoulder pain. It emphasizes the importance of a comprehensive interview with the patient to understand their story and guide the examination. The episode discusses screening for red flags and serious pathologies, utilizing functional disability questionnaires, assessing impairments, providing education and advice, and engaging in shared decision-making. The importance of aligning expectations and revisiting treatment progress throughout the examination process is also highlighted.
Reflecting on teaching and the value of a comprehensive examination
The podcast episode explores the experience of teaching students and the value of moving away from over-reliance on special tests. It discusses the importance of focusing on the subjective examination, history, and conversation with the patient. The episode highlights the need to treat what is found objectively in the context of the patient's subjective experience. It also addresses the board exams and the role of expectations in the examination process.
Chris and Sam sat down with Paul Salamh to discuss his 2020 JOSPT Viewpoint titled, "It Is Time to Put Special Tests for Rotator Cuff-Related Shoulder Pain out to Pasture." Paul is a researcher, professor, and clinician at the University of Indianapolis who specializes in shoulder / upper extremity related conditions. We dive into Paul and Jeremy Lewis' decision to write this piece, identifying the most common shoulder special tests, convergent validity and reference / gold standards, imaging findings and their correlation (or lack thereof) with pain / function, and pre and post test probabilities. We then talk about the recommended examination elements for rotator cuff-related shoulder pain. Lastly, we discuss Paul’s current research project with Jeremy Lewis involving frozen shoulder.
