Requejo-Salinas Néstor, Fernández-Matías Rubén, Cadogan Angela, Chester Rachel, Roy Jean-Sébastien, Struyf Filip, Bateman Marcus, Balster Simon, Haik Melina Nevoeiro, Seitz Amee L, Bisset Leanne, Camargo Paula Rezende, Brismée Jean-Michel, May Stephen, Walker Tom, Wassinger Craig, Lenssen Ross, Powell Jared K, McCreesh Karen, Gibson Jo, Ludewig Paula M, La Touche Roy, Lluch-Girbés Enrique
Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, C/ La Salle, 10, 28023 Madrid, Spain.
International Doctoral School, Rey Juan Carlos University, Alcorcón, Spain.
Phys Ther. 2025 Feb 6;105(2). doi: 10.1093/ptj/pzae133.
There is no established consensus for screening the spine in patients with shoulder pain. The aim of this study was to explore the role of the spine in shoulder pain and generate a set of recommendations for assessing the potential involvement of the spine in patients with shoulder pain.
A modified Delphi study was conducted through use of an international shoulder physical therapist's expert panel. Three domains (clinical reasoning, history, and physical examination) were evaluated using a Likert scale, with consensus defined as Aiken Validity Index ≥0.7.
Twenty-two physical therapists participated. Consensus was reached on a total of 30 items: clinical reasoning (n = 9), history (n = 13), and physical examination (n = 8). The statement that spinal and shoulder disorders can coexist, sometimes influencing each other and at other times remaining independent issues, along with the concept of radiating pain as an explanatory phenomenon for the spine contribution to shoulder pain, achieved the highest degree of consensus.
International physical therapists shoulder experts reached consensus on key aspects when screening the spine in people with shoulder pain, including consideration of the distal location of symptoms relative to the shoulder, the presence or previous history of neck pain, the changes in symptoms related to neck movements, and the presence of neuropathic-like symptoms. They also acknowledged the importance of assessing active cervical or cervicothoracic movements and the usefulness of the Spurling test and symptom modification techniques applied to the spine.
This consensus holds implications for both clinical practice and research. In research, applying these considerations may ensure more homogenous samples, thereby enhancing the investigation of outcomes in shoulder pain populations. In clinical practice, determining the need for spine screening and its potential impact on prognosis and management could significantly influence patient care.
对于肩部疼痛患者的脊柱筛查，目前尚无既定的共识。本研究的目的是探讨脊柱在肩部疼痛中的作用，并生成一套关于评估肩部疼痛患者脊柱潜在受累情况的建议。
通过国际肩部物理治疗师专家小组进行了一项改良德尔菲研究。使用李克特量表对三个领域（临床推理、病史和体格检查）进行评估，共识定义为艾肯效度指数≥0.7。
22名物理治疗师参与。总共就30项达成了共识：临床推理（n = 9）、病史（n = 13）和体格检查（n = 8）。关于脊柱疾病和肩部疾病可能共存，有时相互影响，有时保持独立问题的陈述，以及将放射痛作为脊柱导致肩部疼痛的一种解释现象的概念达成了最高程度的共识。
国际物理治疗师肩部专家在对肩部疼痛患者进行脊柱筛查的关键方面达成了共识，包括考虑症状相对于肩部的远端位置、颈部疼痛的存在或既往史、与颈部运动相关的症状变化以及神经性症状的存在。他们还承认评估主动颈椎或颈胸段运动的重要性以及斯普林试验和应用于脊柱的症状改变技术的有用性。
这一共识对临床实践和研究都有影响。在研究中，应用这些考虑因素可能确保样本更加同质，从而加强对肩部疼痛人群结局的研究。在临床实践中，确定脊柱筛查的必要性及其对预后和管理的潜在影响可能会显著影响患者护理。
