A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders

So still no knowledge of EXACTLY how to treat shoulder pain; guidelines, NOT PROTOCOLS, and  a request for better research. You'll just have to tough it out, while your doctor gets paid for doing nothing.

A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders

• Véronique Lowry, M.Sc.
• Patrick Lavigne, MD, PhD
• Diana Zidarov, PhD
• Eveline Matifat, M.Sc.
• Audrey-Anne Cormier, M.Sc.
• François Desmeules, PhD

Published:October 11, 2023DOI:https://doi.org/10.1016/j.apmr.2023.09.022

ABSTRACT

Objective

To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders.(Whomever approved this objective needs to be fired. The objective should have been to create protocols that cure shoulder pain.)

Data Sources

A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases.

Study Selection

Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis or acromioclavicular disorders published from January 2008 onward were screened and included.

Data Extraction

CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation and surgical treatments). Following semantic analysis of the terminology, recommendations for each shoulder disorders were classified by two reviewers into: “recommended,” “may be recommended” or “not recommended.” Disagreements were resolved by discussion until reviewers reached consensus.

Data Synthesis

Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient's history, subjective evaluation focused on red flags and clinical examination. MRI is not usually recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, six CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas four CPGs did not recommend it.

Conclusions

Recommendations vary for diagnostic imaging, conservative versus surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.