Background Clinicians of many specialties within sports medicine care for athletes with shoulder instability, but successful outcomes are inconsistent. Consistency across specialties in the diagnosis of shoulder instability is critical for care of the athlete, yet the extent of divergence in its diagnosis is unknown. Hypothesis Physicians differ from rehabilitation providers in which findings they deem clinically important to differentiate shoulder instability from impingement, and in how they diagnose athlete scenarios with atraumatic shoulder instability. Study Design Cross-sectional study. Methods Physicians (orthopaedic surgeons, primary care sports medicine physicians) and rehabilitation providers (physical therapists, athletic trainers) were asked via an online survey to rate clinical factors used to diagnose shoulder instability. Clinicians were also asked to diagnose two athlete scenarios with concurrent clinical findings of atraumatic shoulder instability and impingement, differentiated by the absence or presence of a positive sulcus sign. Results Responses were recorded from 888 clinicians. Orthopaedic surgeons (N=170) and primary care sports medicine physicians (N=108) ranked physical examination factors as more important for the diagnosis of shoulder instability than patient history factors, whereas physical therapists (N=379) and athletic trainers (N=231) preferred patient history factors. Orthopaedic surgeons differed from physical therapists and athletic trainers in their clinical diagnoses for both scenarios (P≤0.001). Conclusion A lack of consistency exists among sports medicine clinicians in recognizing which clinical factors are important when used to diagnose shoulder instability and in diagnoses given with concurrent findings of impingement. Level of Evidence Level 3.
|Number of pages||11|
|Journal||International Journal of Sports Physical Therapy|
|State||Published - 2021|
Bibliographical noteFunding Information:
This work was supported in part by the National Institutes of Health (NIAMS F31AR074288, NIGMS T32GM008152), Northwestern University, the American Academy of Sports Physical Therapy, the Academy of Orthopaedic Physical Therapy, and the American Physical Therapy Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
ALS reports grants from the Foundation for Physical Therapy Research and the National Institutes of Health (NICHD 1R01HD098698-01, AHQR 1R01HS027426-01, NCATS UL1TR001422) outside of the submitted work. ALS also serves on the Board of Directors for the American Society of Shoulder and Elbow Therapists, on the Editorial Board for the Journal Orthopaedic and Sports Physical Therapy, and as Vice Chair of the Research Committee for the Academy of Orthopaedic Physical Therapy. XL reports consultant fees, royalties, I.P., and non-financial support from FH Ortho and consultant fees from Mitek-Depuy outside of the submitted work. XL also serves on the Editorial Board for the American Journal Sports Medicine, on the Editorial Board for Orthopedics Review, on the Research Committee for the American Society Shoulder and Elbow Surgeons, and as Sports Medi- cine and Arthroscopy ICL Chair for the American Academy of Orthopedic Surgery. GM reports royalties from Zimmer Biomet outside of the submitted work. For the remaining authors, none were declared.
© 2021, North American Sports Medicine Institute. All rights reserved.
- Multidirectional instability
- Rotator cuff impingement
- Shoulder instability
- Sulcus sign
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
- Orthopedics and Sports Medicine