Ep 11: Are we overcomplicating the shoulder? Tips for assessment and treatment, with Prof Jeremy Lewis and Dr Paul Salamh
Nov 2, 2020
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Prof Jeremy Lewis and Dr Paul Salamh discuss the overcomplication of shoulder assessment and treatment, emphasizing the limitations of imaging and special tests. They highlight the importance of patient education, shifting away from structural diagnoses, and adapting treatment based on presentations rather than specific structures. The podcast also covers the significance of subjective evaluation, functional movement assessment, and patient-driven treatment for shoulder issues.
Special tests for rotator cuff-related shoulder pain are not effective in identifying the source of pain and can lead to harmful interventions.
Physical therapists should prioritize patient goals, provide tailored rehabilitation programs, and exceed patient expectations in the treatment of shoulder pain.
Deep dives
Moving away from structural diagnosis in shoulder pain
The podcast discusses the viewpoint of Dr. Jeremy Lewis and Paul Salom, which argues for moving away from a structure-specific model in the diagnosis and treatment of rotator cuff-related shoulder pain. They propose categorizing patients based on a Venn diagram framework that considers overlap with other shoulder conditions, kinetic chain factors, and psychosocial factors. The aim is to shift focus from identifying specific structures to addressing functional problems and reducing disability.
Reconsidering the use of special tests
The podcast highlights the viewpoint's call to put special tests for rotator cuff-related shoulder pain out to pasture. The speakers argue that these tests are not effective in identifying the source of pain and that basing treatment on structural diagnoses can lead to harmful and unnecessary interventions. They emphasize the need to listen to patient experiences and value patient goals over relying on special tests.
The importance of patient education and tailored treatment
The podcast emphasizes the importance of patient education and shared decision-making in the treatment of shoulder pain. The speakers urge physical therapists to provide sustainable, honest healthcare and move away from over-complicating diagnoses. They advocate for tailored rehabilitation programs that prioritize patient goals, incorporate graded exercise, and may include manual therapy in a limited capacity. The speakers also stress the importance of exceeding patient expectations and promoting functional recovery.
It's time to put shoulder special tests out to pasture. In this episode, Drs Dan Chapman and Chelsea Cooman talk with Prof Jeremy Lewis and Dr Paul Salamh about their recent JOSPT Viewpoint article on the treatment of rotator cuff–related shoulder pain. Prof Lewis and Dr Salamh argue why imaging and shoulder special tests won’t help you identify structures that are contributing to symptoms, then lay out what a shoulder examination looks like without special tests and how to begin treatment.
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