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Using the recent Rotator Cuff CPG

clinician assessing a mans right shoulder

This recent CPG focused on the full continuum of care for rotator cuff disorders, which encompasses all subacromial pain syndromes and similar diagnoses. It does not state anterolateral shoulder pain as labral pathologies are excluded. With respect to physios, the recommendations can be summed up as follows:

  • Do these: "active and task-oriented rehabilitation exercises, potentially including joint mobility exercises, motor control exercises, strengthening exercises, and endurance exercises (there is no best type)

  • Maybe do these: Manual therapy, acupuncture, shockwave therapy, and pain education may provide short-term pain relief. They should be part of a multi-modal plan and not stand-alone treatments.

  • Don't do these: Ultrasound and laser

  • Unknown but probably don't do: Taping, e-stim, and iontophoresis lack sufficient data to draw conclusions.

The treatment approach for the shoulder is similar to other regions of the body. Use a multi-modal approach that is grounded in a personalized physical activity approach that targets the specific needs of the patient. You don't need to restore scapulothoracic rhythm or hammer the low trap and serratus anterior. You don't need to target all of the trigger points in the upper trap. Those interventions may help some people but they are often unnecessary.

As with all CPGs, this document provides the general path. Now you need to fill in the details with trials, experience, and patient goals.

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