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
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.
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