Affiliations: [a] Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, Keele University, Staffordshire, UK
| [b] Derby Shoulder Unit, University Hospitals Derby & Burton NHS Foundation Trust, Derby, UK
| [c]
Aneurin Bevan University Health Board, Caerleon, UK
| [d] Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| [e]
English Institute of Sport, Manchester, UK
| [f]
Royal National Orthopaedic Hospital, Middlesex, UK
| [g] Sheffield Shoulder and Elbow Unit, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| [h] West Herts Shoulder Service, West Hertfordshire Hospital Trust, St Albans Herts, Spire Healthcare, Spire Bushey Hospital, Hertfordshire, UK
| [i] Nottingham Shoulder & Elbow Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
Correspondence:
[*]
Corresponding author: Chris Littlewood, Research Institute for Primary Care and Health Sciences, Keele
University, Staffordshire, UK. Tel: +44 1782 734832; E-mail: c.littlewood@keele.ac.uk.
Abstract: BACKGROUND:Disorders associated with the rotator cuff are regarded as the most common shoulder pain presentation. The range of diagnostic terms used to explain this problem reflect uncertainty in relation to causative mechanisms, diagnosis, prognosis, and the most effective treatments. The aim of this consensus exercise was to facilitate a shared understanding as a means of reducing mixed messages, informing clinical practice and providing a foundation for future research. METHODS:Nine physiotherapists with clinical and academic expertise in shoulder pain participated in an online and face-to-face consensus exercise. RESULTS:This consensus exercise suggests specific factors in the history and physical examination that might raise the index of suspicion of Rotator Cuff Related Shoulder Pain. The suggestions for non-surgical management include a minimal number of exercises prescribed to challenge the functional deficit of the patient over a minimum 12-week period. Apart from aiding exclusion of red flag pathology, imaging is not regarded as useful unless the patient does not respond as expected. Steroid injections wouldn’t be considered a first-line intervention unless pain was severe and preventing engagement with exercise. CONCLUSION:This consensus exercise provides a benchmark for clinical reflection while highlighting areas of uncertainty that still exist and require further research.
