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Clinical assessment of shoulder complaints

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Clinical assessment of shoulder complaints

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Subacromial impingement of the rotator cuff tendon is the most frequent cause of shoulder pain and disability. The diagnosis of subacromial impingement syndrome (SIS) is often a challenge in clinical practice due to its broad spectrum of presentation. Moreover the signs and symptoms manifested by other shoulder pathologies are similar to those of SIS. Depending on the pathological stage of SIS, most patients will respond to conservative treatment. Purpose: A systematic review of diagnostic studies and of RCT’s on intervention was conducted in order to determine the accuracy of clinical tests in the diagnosis of SIS and examine the effects of manual therapy and therapeutic exercises as treatment methods. Methods: A literature search was performed using the computerized databases PubMed, science Direct, Cochrane, PEDro, Medline, EMBASE and British Journal of sport Medicine. Two criteria lists- the PEDro scale and the QUADRAS tools were used to assess the methodological quality of the selected articles. For diagnostic studies, data on sensitivity, specificity, PPV, NPV and LR’s were extracted. For the intervention studies, data on intervention type, outcome measures and treatment effects were extracted. Results: The two component result (Diagnosis and treatment of SIS) was determined by summarizing and evaluating the data from the studies. A quantitative analysis of the results was performed. The LR’S and predictive values were used to determine the diagnostic accuracy of clinical tests and levels of evidence was used to define the effectiveness of the treatment interventions. Conclusion: The diagnostic accuracy of individual clinical tests for the different stages of SIS was found to be low. The clinical tests can be used to rule in or rule out the presence of a rotator cuff lesion but a valid reference standard test is required to confirm the diagnosis. Moderate evidence was found that combining manual therapy techniques with therapeutic exercises result in better improvements in pain intensities, strength and functional loss in SIS patients in short term follow-up compared to using exercise interventions alone.

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OrganisatieHogeschool van Amsterdam
InstituutGezondheid
Gepubliceerd in
Jaar2011
TypeBachelorscriptie
TaalEngels

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