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


CONCLUSIONS
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.
Robb
Gillian
G
Section of Epidemiology & Biostatistics, School of Population Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand. g.robb@auckland.ac.nz
Arroll
Bruce
B
Reid
Duncan
D
Goodyear-Smith
Felicity
F
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular; D007592:Joint Diseases / Q000175:diagnosis* / Q000628:therapy*; D009984:Orthopedic Fixation Devices; D011320:Primary Health Care; D000070599:Shoulder Injuries; D020069:Shoulder Pain / Q000175:diagnosis*; D017695:Soft Tissue Injuries
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids