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Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence – a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)
  1. Behnam Liaghat1,2,
  2. Julie Rønne Pedersen1,
  3. Rasmus Skov Husted3,4,5,6,7,
  4. Lisbeth Lund Pedersen1,8,
  5. Kristian Thorborg3,9,
  6. Carsten B Juhl1,10
  1. 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  2. 2Centre for Evidence-Based Orthopaedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
  3. 3Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark
  4. 4Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
  5. 5Center for General Practice, Aalborg University, Aalborg, Denmark
  6. 6Clinical Orthopedic Research Hvidovre (CORH), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
  7. 7The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
  8. 8Danish Society of Sports Physical Therapy, Odense, Denmark
  9. 9Department of Orthopaedic Surgery, Sports Orthopedic Research Center – Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
  10. 10Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
  1. Correspondence to Dr Behnam Liaghat, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense 5230, Denmark; bliaghat{at}health.sdu.dk

Abstract

This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.

For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).

For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).

For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C–40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for clinical practice.

  • Athletic Injuries
  • Exercise
  • Rehabilitation
  • Shoulder
  • Sporting injuries

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Footnotes

  • BL and JRP are joint first authors.

  • Twitter @behnam_liaghat, @JulieKRPedersen, @Husted_RS, @Lislunped, @KThorborg, @BoghJuhl

  • Contributors BL, JRP, RSH, KT, LLP and CBJ conceived the study idea. BL and JRP performed the systematic searches with input from RSH, KT, LLP and CBJ. BL and JRP conducted risk of bias assessments and GRADE assessments. BL and JRP wrote the initial draft. All authors revised the draft critically and agreed on the final version.

  • Funding The Danish Society of Sports Physical Therapy initiated the project and provided financial support to authors (BL, JRP, RSH, LLP and KT).

  • Competing interests KT is Deputy Editor in BJSM. KT and JRP have received grants from the Danish Society of Sports Physical Therapy unrelated to the present study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.