Diagnosing and Treating Shoulder Injuries in Sports | Podcast Ep. 455

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research. It is all about the shoulder. A fantastic study, lot of clinical pearls we're going to get into it and much more on today's episode. But before we get started, let me say a few words about Jane. Today's episode is sponsored by Jane, my favorite emr. Jane has designed user friendly online booking so your patients have the freedom to book their appointments at their convenience, even if it's after hours or on weekends. They can also manage those appointments, fill out intake forms, enable appointment reminders, all of which saves you time. And as a listener, you can get a one month grace period using the code EBC1MO. Click the link down in the show notes, have a conversation with their team and watch your practice get streamlined. But as I said at the top, this is all about research today and it is about the shoulder. The title of the study we're going to highlight is Diagnosis, Prevention and Treatment of Common Shoulder Injuries in Sport Grading the Evidence, a statement paper commissioned by the Danish Society of Sports Physical Therapy. That is a mouthful. I will drop a link down below in the show notes so if you want to check it out yourself, you can do so. But I know there's a lot of docs listening, maybe you, that are really interested in sports care, whether that's sports performance, whether that's injury prevention, whatever it might be. Sports chiropractic is one of the fastest growing segments of chiropractic, hands down. And with that comes a lot of shoulder challenges. The shoulder is the most unstable joint in the body, as we all know. And with many sports it's highly susceptible to pain, dysfunction and injury. And in many sports, if somebody's experiencing pain, dysfunction and injury, it puts them totally out of commission. And that's a massive deal for everybody. I mean, we used to think of this in terms of, wow, that's a big deal for a professional because they have money on the line. Well, that's true. And then we added on college and college sports became so large, there was a lot of money involved there as well, and the ability to continue your education, et cetera. It became a big deal. Chiropractic and specifically the shoulder treatment, injuries prevention in college. Now we trace that back even to high school and younger in terms of people becoming super specialized. Conversation for a different day on whether that's a good thing or a bad thing. But people becoming super specialized super early. And if you deal with injuries pretty early, you're really gonna be challenge, let's say, as time goes on. Because as everybody listening to this podcast knows, time and gravity are undefeated. So if you are struggling with shoulder injuries early on in your playing career, and I mean early on, meaning as a child, as a kid, at his adolescent, it does not bode well for you to be able to continue playing at a super high level. And we all know that shoulder injuries are frequently seen in an array of sports. Swimming, football, volleyball, handball, big baseball, pretty much anything where there are movements performed repeatedly over the head at high speed. And that's a lot of sports that are really, really key, I would say culturally in the United States and beyond for that matter. And athletes from these sports are often referred to as, quote, unquote, overhead athletes. And it is now accepted that there's a significant risk for sustaining shoulder injuries. And what do those risks look like? They're probably going to be pretty shocking to you in swimming. Up to 38% of athletes will sustain shoulder injuries within one year. That's wild. 23% of volleyball players experience dominant shoulder pain during any individual season. So this is a lot of people. This is not, you know, one, this is, you look at the amount of people on the court playing volleyball and that means one, one of them probably has shoulder pain going on right then probably two, in that case, swimming. Up to 40% nearly of individuals having shoulder injuries. So this is a really big deal. And if you can get good at diagnosing, at treating at the base level, discussing shoulder injuries, this is going to open up a world of opportunity for you and your practice taking care of these individuals. They're going to be super grateful for it because, because I can tell you, shoulder pain is tough and we all know on the far extreme that we're gonna outside of high level sport. But sometimes this can even happen to people at high level sport. Shoulder hurts. They're not moving so much. Fast track to frozen shoulder. Now you're talking about an extended period of time that becomes challenged. And they had a study done previously of handball athletes and it was up to 75% of them had had previous shoulder pain. Up to 52% had current shoulder pain and the prevalence of weekly shoulder pain was up to 28%. That's massive. And this is all these rates are not only seen in handball, they're also seen in other overhead sports such as baseball, water polo, et cetera. That is a massive deal. That's a massive opportunity and it's really a way that you can significantly help people. Why? Because the Shoulder is inherently unstable. And because of that, I'm going to put my limb out, go out on a limb and say movement based care is one of the best things you can do. And really being able to guide and direct people. If somebody's experiencing shoulder pain, yes, a medication might decrease the pain temporarily, but nobody's under the assumption that that takes care of the issue. Now, on the other end, if we push it way far out, yes, sometimes people deal with significant injury that requires surgical intervention, but thankfully that's a minority of individual. Now, how do these injuries happen? Well, there's a couple different ways. Shoulder injuries can result from instantaneous transfer, they say, of large quantities of energy. In other words, acute with a sudden onset. It also can be the opposite, which is like with most injuries, gradual accumulation of low energy activities over a period of time, repetitive. Repetitive, repetitive. Right. Or a combination of both mechanisms, repetition and repetitive motion, then with a sudden onset. So nothing particularly new there. But with this study, they specifically looked at three domains. Diagnosis domain one, prevention domain two, and treatment of five common shoulder injuries, which was domain three. Those included things like subacromial impingement syndrome, sis, internal posterior superior impingement, biceps labrum complex injuries, radio rotator cuff injuries, and anterior instability. So that is what this study was looking at. And if we pick it up right at domain one, that starts with diagnostic test, they looked at over 1200 studies, narrowed it down to a handful, and then they subdivided these studies based upon the diagnosis that the diagnostic test was trying to figure out. And they started with subacromial impingement syndrome. They discovered one test battery, what's called the composite test, used five of the most commonly used tests in clinical practice. What are these? Probably some of them are going to sound familiar. Hawkins, Kennedy test, the near test, painful arc test, empty can test, and external rotation against resistance. And these showed low to moderate diagnostic accuracy. So if you're using one or a combination of multiple low, and let me be clear, low to moderate diagnostic accuracy does not mean the test is not good. What it simply means is that it's low to moderate in its accuracy. So when you get a negative, that means, well, it doesn't necessarily mean it's 100%. So make sure you're going through your range of motion, you're asking questions as the case, most of the time, a single orthopedic test is rarely the answer. It's the combination of items. How is that patient presenting? How were they injured? What's their pain like? How are they describing it? Oppqrst what does their history seem like? They have previous history. Right. All of those things play a role, including the diagnostic test. Now they also looked at anterior instability and they found that the apprehension test had a high diagnostic accuracy when positive. The relocation test showed moderate diagnostic accuracy. So if some of these test names not a shoulder expert. So some of these don't sound super familiar to me, but if they sound familiar to you, this is important stuff to understand. How accurate are these tests? The biceps labral complex. So this was that complex of injuries. Well, the biceps load test showed high diagnostic accuracy. And the diagnostic accuracy of the three pack test, as they call it, active compression throwing test and bicipital tunnel palpation with was also shown to have high diagnostic accuracy across the board. So active compression showed high accuracy when negative. Bicipital tunnel palpation showed high accuracy when negative. And additionally the throwing test had high accuracy when negative. So important to keep those in mind. Now as we move on to the last injury associated with diagnostics, that's a rotator cuff injury. Five clinical tests were highlighted. Painful arc, the liftoff test, external rotation against resistance, full can and empty can. And all tests showed low diagnostic accuracy. Now a few of those tests sound familiar to me and I was surprised to hear with a rotator cuff injury they have low diagnostic accuracy. Again, that doesn't mean that they are not applicable to use. It just means, hey, take into account beyond that test alone, everything that's going on with the patient, which is probably what you're doing anyway. Now in domain number two, they were looking at prevention and here is where things get super interesting. They had something called the Oslo Sports Trauma Research center shoulder injury prevention program. Wow, that is long. And those individuals performing the Oslo Sports Trauma Research center shoulder injury prevention program there I did it, I said it during warm up three times a week for seven months had nearly a 30% lower risk or odds of shoulder injuries. That's impactful right there. I'm not familiar with the ostrc, but I'm gonna look it up now. Why? Because we see almost a 30% reduction in shoulder injury when somebody is staying consistent with that. They also highlighted something called the shoulder control program which focused on shoulder and trunk strength and control trunk mobility and handball. Throwing load could be throwing load of any Sport really. Performed three times weekly, 56% lower shoulder injury rate compared with usual care. So those are two programs. If you're interested in prevention, guiding and directing people in your practice in your community, those are probably two really, really great programs to look into because they have significant decreases in the likelihood of injury. And finally, in domain number three, they were looking at treatment. They broke it up by a couple different diagnosis, I guess you could say so. With subacromial impingement syndrome, limited evidence overall was found to guide the treatment of that impingement syndrome. They did see a study of 47 young athletes that showed reductions in pain and disability following daily shoulder strengthening exercises. So if you are going through a strengthening program, that's probably the best thing. It was pretty low in terms of the quality of the evidence. However, it was still there. Now, in terms of supraspinatus tendinopathy, heat, hyperthermia experience significant improvements in pain. So heat actually helped. And in terms of what I'll call generalized shoulder pain, the highest quality of evidence was found for one session of anterior posterior mobilization of the glenohumeral joint. The group receiving this mobilization experienced a statistically significant reduction in shoulder pain measured using an NRS scale. So overall high diagnostic accuracy was observed for 10 tests covering anterior instability, slap injuries and biceps complex injuries. Additionally, that Ostrc Shoulder Injury Prevention program really does a fantastic job at lowering the risk and likelihood of a shoulder injury. And there was, as I say, low to moderate quality evidence in terms of treatment for exercise based treatment for subacromial impingement and shoulder pain. So I found this study absolutely fascinating. Their conclusions were for prevention based on a few high quality studies. Implementing a shoulder injury prevention program showed a moderate to large effect in reducing the risk of shoulder injuries compared to no intervention for the treatment of select shoulder injuries. Choosing an active rehabilitation program seems to be beneficial compared with passive modalities in reducing pain and disability. End quote. And that really is the take home message. Again. I will drop this link down below. If you're somebody that takes care of athletes with shoulder injuries, I'm gonna highly recommend to check out those shoulder program can help with prevention. And my take home message with this as far as treatment is, hey, if you're doing active care, that's a really good thing. Passive modalities can help reduce pain. There is viability there in the short term. But ultimately to get that maximum benefit, it looks as though strengthening active care is gonna get you and them most importantly where they want to be. So great study, lots of many clinical pearls there and a great opportunity to learn more about shoulder prevention injury prevention programs in your practice. Now as we wrap up today's episode, I wanna say a few words about neck care. If you are into shoulder diagnostics, chances are you can, should and are into Neck Diagnostics Cervical Spine Diagnostics the objective assessment of cervical spine. The best tool out there by far. Neckcare necare.com, super easy to remember neckcare.com reliable assessments for neuromusculoskeletal control, proprioception, range of motion and sensory motor integration. Their units are fantastic. Their software and hardware is like nothing you've seen. Check it out neckcare.com, tell em you got sent over from the Evidence based Chiropractor and they will hook you up. And finally, did you know that your patient list is the most valuable asset in your practice? If not, head over to smartchiropractor.com we recently released a Reactivation opportunity calculator that's fancy for saying see how much your list is worth. Head over to smart chiropractor.com, scroll down a little bit, use our tool, move around the sliders and see just how much opportunity is sitting in your list. The smartchiropractor.com I'll drop all those links down in the show notes. I hope you have a fantastic week in practice and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to go faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today. Sam.