PTSurveyInternational journal of sports physical therapy2021

Interprofessional Inconsistencies in the Diagnosis of Shoulder Instability: Survey Results of Physicians and Rehabilitation Providers.

Constantine P Nicolozakes, Xinning Li, Tim L Uhl and 4 others

PMID 34386289

WHAT IT FOUND

Sports medicine clinicians disagreed about shoulder instability diagnosis.

Physicians leaned on examination tests, while physical therapists and athletic trainers leaned on history. A positive sulcus sign shifted most clinicians toward multidirectional instability.

Key findings

01Physician specialties ranked apprehension and relocation tests as top factors, while physical therapists and athletic trainers ranked history of significant trauma and repetitive overuse among their top three.

02In a scenario with a negative sulcus sign, orthopaedic surgeons chose secondary impingement 62% versus 48-54% for other specialties.

03Adding a positive sulcus sign to the otherwise identical scenario shifted most clinicians to multidirectional instability, and orthopaedic surgeons selected it least often.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

Responses came from self-selected clinicians contacted through professional organizations and social media, so they may not represent all shoulder care providers. Of 1202 responses, 897 completed and 9 were excluded, leaving 888 analyzed; this may not reflect all clinicians. The survey asked about written scenarios, not real patients, and the scenarios were short, exam-heavy, and omitted additional clinical, radiographic, and demographic information. It measured perceived importance and scenario choices, not diagnostic accuracy or patient outcomes. Some clinical factors used in practice were not rated.

Declared interests

Funding: NIH (NIAMS F31AR074288, NIGMS T32GM008152), Northwestern University, American Academy of Sports Physical Therapy, Academy of Orthopaedic Physical Therapy, American Physical Therapy Association. ALS reports grants from the Foundation for Physical Therapy Research and NIH outside the submitted work, and roles with the American Society of Shoulder and Elbow Therapists, Journal Orthopaedic and Sports Physical Therapy, and 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 the submitted work, plus editorial and society roles. GM reports royalties from Zimmer Biomet outside the submitted work. Remaining authors declared none.

The easy way to misread this

Do not read this as proof that one specialty diagnoses shoulder instability better or that any treatment works. It reports self-selected clinicians' ratings and choices in brief written scenarios, not real diagnostic accuracy or patient outcomes.

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The study

Participants
888 sports medicine clinicians analyzed (170 orthopaedic surgeons, 108 primary care sports medicine physicians, 379 physical therapists, 231 athletic trainers)
Certainty of evidence
Low

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Constantine P Nicolozakes, Xinning Li, Tim L Uhl, et al. Interprofessional Inconsistencies in the Diagnosis of Shoulder Instability: Survey Results of Physicians and Rehabilitation Providers. International journal of sports physical therapy. 2021.

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