Have you encountered situations where you weren’t exactly sure what the problem was with one of your patients, especially when it comes to the diverse issues that can arise with shoulder pain? Find out the facts in our latest article Shouldering the Pain: New Tech Leads PT Practices into Patient Relief & Practice Success.
The numbers don’t lie. No matter if you are young or old, an athlete, a techie or a couch potato, there is a very good chance you have had to deal with shoulder issues. In the U.S. today, about 67 percent of the population will at some point experience shoulder pain.
More than 7.5 million people have visited their doctor’s office for shoulder problems, with most of them being treated at PT practices across the U.S. Their issues run the gamut from computer-posture aches to shoulder and upper arm sprains, strains and frozen shoulders. And over 4.1 million people visited physical therapists for rotator cuff problems in 2018.
Shouldering the Pain: New Tech Leads PT Practices into Patient Relief & Practice Success
Shoulder pain is one of the most common problems that physical therapists treat in clinical practice. Prevalence one month of shoulder and arm pain was reported to be about 30% (1). Most commonly, patients with symptoms are broadly categorized into a single diagnosis of shoulder pain without knowledge of specific structures causing the symptoms.
Clinical tests are not enough to differentiate the wide range of pathology related to shoulder- neck area which often can be confusing because of their similar presentation . List of possible shoulder pathology is shown on page 7(click here to view entire article). The possible causes are divided into two categories, neural and non-neural. Physical examination, history taking, and special tests may not provide complete information about the cause of shoulder complaints. Appropriate use of Electrodiagnosis and Ultrasound imaging can provide gainful insight into specific pathology and therefore improve clinical decision-making and management of the patient. High levels of patient satisfaction and patient perceived value has been reported when clinic-based ultrasound imaging was used in outpatient facilities  since it helps the patient understand their problem and improves their confidence in the provider.
Differentiating cervical radiculopathy, thoracic outlet syndrome, or other neural pathology from primary shoulder disease can present a difficulty owing to the proximity and overlap of symptomatology . Appropriate use of EMG/NCS studies can tease out the neural component of the shoulder pain. EMG/NCS studies can distinguish possible neural pathologies contributing to shoulder pain, weakness and abnormal dynamics. These abnormalities are seen as abnormal responses in nerve conduction studies and positive needle EMG findings from the selected muscles of the affected myotome.
Adding ultrasound imaging to the physical examination provides gainful insight into the localization of pathology and also points towards the temporal component of the disease. For full- thickness rotator cuff tear, ultrasound imaging has been reported to have sensitivity of 60%; specificity of 100%, positive predictive value of 100%, negative predictive value of 78% and accuracy of 84% . Ultrasound imaging is considered equally effective as MRI in pathology related to the rotator cuff  and has an added advantage of real time evaluation and use of dynamic imaging– which is not possible with MRI.
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- Luime, J.J., et al., Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology, 2004. 33(2): p. 73-81.
- Karel, Y.H.J.M., et al., Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management. Physiotherapy, 2016.
- Wheeler, P., What do patients think about diagnostic ultrasound? A pilot study to investigate patient-perceived benefits with the use of musculoskeletal diagnostic ultrasound in an outpatient clinic setting. International Musculoskeletal Medicine, 2010. 32(2): p. 68-71.
- SG, M. and M. PD, Cervical radiculitis and shoulder disorders. Clin Orthop Relat Res., 1999. 368: p. 105-13
- Jacobson, J.A., et al., Full-Thickness and Partial-Thickness Supraspinatus Tendon Tears: Value of US Signs in Diagnosis. Radiology, 2004. 230(1): p. 234-242.
- Vlychou, M., et al., Symptomatic Partial Rotator Cuff Tears: Diagnostic Performance of Ultrasound and Magnetic Resonance Imaging with Surgical Correlation. Acta Radiologica, 2009. 50(1): p. 101-105.