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Shoulder pain - where are we now?

Shoulder pain - where are we now?
Shoulder pain - where are we now?
Purpose of review: shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified.

Recent findings: imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit.

Summary: much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.
Introduction
285–306
Walker-Bone, Karen
ad7d1336-ed2c-4f39-ade5-da84eb412109
van der Windt, Danielle AWM
7d958e6a-a203-4a17-8a32-8ed3e0343aeb
Walker-Bone, Karen
ad7d1336-ed2c-4f39-ade5-da84eb412109
van der Windt, Danielle AWM
7d958e6a-a203-4a17-8a32-8ed3e0343aeb

Walker-Bone, Karen and van der Windt, Danielle AWM (2021) Shoulder pain - where are we now? Current Treatment Options in Rheumatology, 7, 285–306. (doi:10.1007/s40674-021-00184-z).

Record type: Article

Abstract

Purpose of review: shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified.

Recent findings: imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit.

Summary: much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.
Introduction

Text
CLEAN Final manuscript after reviewer comments 14.6.21 - Accepted Manuscript
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More information

Accepted/In Press date: 5 July 2021
e-pub ahead of print date: 5 August 2021
Published date: 1 December 2021

Identifiers

Local EPrints ID: 450281
URI: http://eprints.soton.ac.uk/id/eprint/450281
PURE UUID: d694f65c-4b4c-4c14-b4e9-a82e584c5c2a
ORCID for Karen Walker-Bone: ORCID iD orcid.org/0000-0002-5992-1459

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Date deposited: 20 Jul 2021 16:31
Last modified: 17 Mar 2024 02:50

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Author: Danielle AWM van der Windt

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