Physiotherapeutic Assessment and Treatment of Muscle-tendon-associated Shoulder Pain

Abstract Since November 2024, various shoulder pathologies can be treated on the basis of a so-called “blank prescription” in Germany. This means that physiotherapists are free to choose the type of treatment and frequency. Suitable practice guidelines would be helpful to make this process more transparent and provide a decision-making corridor. Although guidelines from the Association of Scientific Medical Societies in Germany (AWMF) provide instructions regarding recommended and non-recommended interventions, they do not comment on the physiotherapy examination or the exact parameters for treatment. To evaluate the question: What recommendations can be made for the physiotherapy examination and treatment of patients with shoulder complaints? In order to create a basis for the development of a German-language physiotherapy practice guideline, a team of physiotherapists from the fields of clinical practice and science translated, summarized and commented on English-language practice guidelines on muscle-tendon-associated shoulder pain. Text passages and recommendations from literature were transferred into a joint document by at least 2 people per guideline, summarized in 4 consensus conferences and reviewed for the need for updates. Eight international guidelines were analyzed. The following objectives were identified for the medical history and physical examination: (1) recognition of red flags, (2) recognition of clinical patterns and differentiation of various shoulder pathologies, (3) assessment of impairment at the functional and participation level and (4) selection of initial treatment. The following physiotherapy goals were set for the treatment: (1) minimization of pain and reduction of acute signs of inflammation, (2) improvement of mobility, strength, stability and posture, (3) promotion of self-management, (4) reduction of psychosocial risk factors and promotion of participation. For these objectives, recommendations were derived from literature or, in the absence of information, a gap in evidence was pointed out. The results of this study present the current evidence on international practice guidelines as a basis for systematic reviews on the identified topics, which in turn enable the creation of a practice guideline.