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Differential Diagnosis of Shoulder Pain in Physical Therapy: An Algorithm for Clinical Reasoning

Abstract:

Shoulder pain is a frequent cause of musculoskeletal consultation in primary care, whose etiology of non-neurological origin may include the Rotator Cuff Disorders, Subacromial impingement, Glenohumeral Instability, Long head of the biceps lesion, and SLAP. The physiotherapeutic management of this pathology, as well as its effectiveness, starts from a well-structured differential diagnosis, which is based on the clinical reasoning process. To determine the cause of shoulder pain, the literature shows innumerable tests that can be applied during the evaluation. The aim of this manuscript is to assist the therapist in defining the specific type of musculoskeletal shoulder injury from pain of non-neurological origin. A clinical reasoning algorithm is proposed to facilitate the differential diagnosis of painful shoulder pathology in physical therapy based on clinical, visual, manual, functional, and instrumental diagnosis. This tool will allow the identification of the phases of clinical reasoning in the physical therapist, to elaborate the differential diagnosis of painful shoulder pathology, providing a novel tool in their training.