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)

• Published in: British journal of sports medicine Vol. 57; no. 7; pp. 408 - 416
• Main Authors: Liaghat, Behnam, Pedersen, Julie Rønne, Husted, Rasmus Skov, Pedersen, Lisbeth Lund, Thorborg, Kristian, Juhl, Carsten B
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine 01.04.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Athletic Injuries; Bias; Clinical outcomes; Cohort analysis; Denmark; Exercise; Exercise Therapy - methods; Handball; Humans; Injuries; Intervention; Medical diagnosis; Medical Subject Headings-MeSH; Observational studies; Pain; Physical therapy; Prevention; Rehabilitation; Review; Rotator cuff; Shoulder; Shoulder Injuries - diagnosis; Shoulder Injuries - prevention & control; Shoulder Pain - therapy; Sporting injuries; Sports; Systematic review; Volleyball; Denmark; Sporting injuries; Exercise; Rehabilitation; Shoulder; Athletic Injuries
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2022-105674

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.