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).

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.

Use of Physical Therapists to Identify and Treat Musculoskeletal Injuries at "The Tip of the Trident".

Musculoskeletal injuries continue to be the most common cause of decreased readiness and loss of productivity in all military environments. In commands with smaller footprints, such as Naval Special Warfare (NSW), every asset is critical for mission success. Studies have shown that early intervention by a medical provider can enhance healing and maintain unit readiness by preventing medical evacuations. Reports are limited with regard to Special Forces commands, especially during deployment. This article describes the injury characteristics and treatment of injuries seen by a physical therapist while deployed at forward operation commands embedded with NSW Group 2 Team 4. Over 4 months, 282 patients were evaluated and treated in southeast Afghanistan. In descending order, the three most common injured body regions were the lumbar/sacral spine (n = 82), shoulder (n = 59), and knee (n = 28). Therapy exercises (n = 461) were the most frequently performed treatment modality, followed by mobilization/manipulation (n = 394) and dry needling (n = 176). No patient evaluated was medically evacuated from the area or sent to an advanced medical site. Our data are similar to other published data reported on deployed units in terms of mechanisms and locations of injuries; thus, Special Forces commands do not appear to have unique injury patterns. These results support continued use of physical therapists in forward operations because of their ability to evaluate injuries and provide treatment modalities that help maintain the integrity of small commands at the site of injury.

In-vivo measurements of force and humeral movement during inferior glenohumeral mobilizations.

BACKGROUND: Inferior joint mobilization has been proposed as an assessment technique and an intervention for individuals with shoulder dysfunctions. While such techniques are common, few quantitative in vivo measures of manual movement of the humeral head have been reported. OBJECTIVE: The purpose of this study was to measure in vivo inferior translational movements occurring in the glenohumeral joint during manual mobilization techniques and to determine the intratester reliability of those inferior translational movements. DESIGN: Cross sectional reliability study. METHODS: Twenty three healthy volunteers participated. Subjects were positioned supine with the shoulder in 55 degrees of abduction and 30 degrees of horizontal adduction. Visualizing the humeral head and the acromion, ultrasound images of the superior aspect of the glenohumeral joint were taken with the arm at rest and as an examiner applied a grade 1, a grade 2 and a grade 3 inferior mobilization. This process was repeated three times on each shoulder. Humeral head position was measured in reference to the superior aspect of the acromion and the amount of inferior movement determined by the distance the humeral head moved from the rest position. RESULTS: The mean differences between the rest position and a grade 1, a grade 2 and a grade 3 mobilization were 0.96 mm, 2.44 mm and 3.64 mm respectively. Intraclass correlation coefficients (ICC) for movements were moderate for grade one (ICC = 0.681) and good for grade 2 (0.889) and grade 3(0.898). CONCLUSIONS: Results support the ability of one examiner to reliably reproduce three different grades of inferior mobilization.