STRATEGIES FOR SHOULDER IMPINGEMENT AND TENDON PATHOLOGY
Plans of care for patients dealing with shoulder pain can vary from weeks to months depending on the specific pathology and stage of the condition (pain acuity). Additional factors that can impact outcomes and length of care can include the patient’s age and general health, mental status, and level of desired functional return. 38 Thoughtful consideration should be given to these factors when making a prognostic plan of care for any shoulder patient. Pain reduction and restoring range of motion (ROM) are usually the top priorities for most shoulder conditions requiring clinical care. Getting pain under control is paramount to improving ROM and function and is also a critical component of gaining patient trust and improving patient compliance.
How important is it? In today’s climate of high deductibles/ co-pays, approximately 20% of tendinopathy patients self-discharge within the first three visits, while 70% of patients fail to complete their full plan of care. A white paper from Marquette University states that a lack of immediate results is one of the leading causes of high attrition rates. Data suggest that high symptom severity and low functional ability increase the rate of self-discharge. 63 Educating patients that conservative care can help most shoulder problems is as important as proving it. Clinicians’ choices to address problems with pain, ROM, and functional deficits are based on various factors, including the specifics of the patient profile and diagnosis, as well as the technology they have at their disposal. When addressing shoulder impingement and tendinitis, clinicians should be mindful of 5 basic components. 39
#1 Identify and remove any external factors
• Ensure there are no external, anatomical causes for the impingement. This could include surgical considerations regarding bone spurs and soft tissue abnormalities. • Address functional components that may create impingement due to poor posture, i.e., poor scapular position and/ or glenohumeral positioning.
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