EP 2: Spesifisitetsproblemet, kulturell bagasje og selvsikkerhetens luftslott

I denne episoden diskuterer vi problemet rundt spesifisitet. Hvorfor diagnostiseres 90% av korsryggspasienter med "uspesifikke korsryggssmerter" mens vi i andre ledd er mer spesifikke med mindre forskning?

Vi tar utgangspunkt i kvalitativ forskning på subakromielt impingement og diskuterer hvordan vi rammer inn budskapet i vår kommunikasjon med pasienten har mye å si for den konteksten vi skaper for behandling og ultimativt hvor vellykket vi er med vår rehabilitering.   Hvordan har den kulturelle bagasjen og finansieringen av intervensjoner formet skulderområdet?


AKTUELL LITTERATUR:
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Neer, C.S., 2nd: Impingement lesions. Clin Orthop Relat Res, 1983(173): p. 70-7.

Neer, C.S., 2nd: Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am, 1972. 54(1): p. 41-50.

Brox, J.I., et al.: Arthroscopic surgery compared with supervised exercises in patients  with rotator cuff disease (stageII impingement syndrome). BMJ, 1993. 307(6909): p. 899-903.

Ketola, S., et al.: Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome? A TWO-YEAR RANDOMISED CONTROLLED TRIAL. J Bone Joint Surg Br., 2009. 91(10): p. 1326-34.

Ketola, S., et al.: Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment? Acta Orthop, 2015. 86(6): p. 641-6.

Ketola, S., et al.: Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years. Bone Joint J, 2017. 99-B(6): p. 799-805.

Haahr, J.P., et al.: Exercises may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4-8-years' follow-up in a prospective, randomized study. Scand J Rheumatol, 2006. 35(3): p. 224-8.

Haahr, J.P., et al.: Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis, 2005. 64(5): p. 760-4.

Paavola, M., et al.: Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ, 2018. 362: p. k2860.

Beard, D.: Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 2017.

MUSIKK: 

Joseph McDade-Mirrors