Summary of an evidence-based guideline on soft tissue injuries and related disorders – Part 2: Management

Abstract

AIM: To provide a succinct summary of the management of soft tissue injuries to the shoulder for primary health care practitioners based on the New Zealand guideline. METHODS: A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tool for Epidemiology (GATE); and the Scottish Intercollegiate Guideline Network. Recommendations were derived from resulting evidence tables. RESULTS: For the management of soft tissue shoulder disorders there is little evidence to support or refute the efficacy of common interventions for shoulder disorders in general and rotator cuff disorders in particular. For rotator cuff tendinosis and partial tears, use NSAIDs and subacromial corticosteroid injections with caution and provide a trial of supervised exercise. For frozen shoulders, intra-articular corticosteroid injection should be considered and refer for supervised exercise after acute pain has settled. For shoulder instability, good evidence supports the referral of physically active young adults for orthopaedic intervention following a first traumatic shoulder dislocation. CONCLUSION: While there is a dearth of good evidence, this guideline does provide a framework for the management of common soft tissue injuries of the shoulder. KEYWORDS: Shoulder, soft tissue injuries, primary health care