Evaluation and Treatment of Shoulder Pain

Jared Powell

C LAS S OV E RV I E W
The management of rotator cuff related shoulder pain is in the midst of a revolution. Historically gold
standard interventions are being challenged by research findings. Notably, rotator cuff repair surgery,
subacromial decompression surgery, and even exercise therapy has failed to demonstrate efficacy
over placebo or superior effectiveness when compared to each other. Scapular dyskinesis as a clinical
impairment, the construct of poor posture, and the utility of manual therapy are other dogmatic
theories that are being viewed with increasing scepticism.
So, where to from here? What does the future hold for management of rotator cuff related shoulder
pain (RCRSP) and is physiotherapy central to it? Learn all this and more in this eye-opening Masterclass.

1 Copyright © Physio Network

P RESENTER bi o
Jared is an experienced musculoskeletal physiotherapist from the Gold
Coast, Australia. He has an interest in the shoulder joint and is currently
studying for a PhD in this area. Jared teaches on the shoulder globally
to critical acclaim and has written several book chapters, peer reviewed
articles and presented at various conferences on a wide variety of topics,
including frozen shoulder, rotator cuff related shoulder pain, and shoulder
instability. Not simply an educator or academic, Jared is a clinician and runs
a niche shoulder injury clinic on the Gold Coast.

Module Summaries Learning objectives:

Module 1: History and context
This first module will explore where Physiotherapy
as a profession came from and where the core
roots of the Profession lie. It will also discuss how
these roots influence where the profession is
today and current practices of musculoskeletal
clinicians.
Learning objectives:
1. Understand the basic history of physiotherapy .
2. Describe how the history of physiotherapy
influences modern day clinical practice.
Module 2: Subacromial impingement and
scapular dyskinesis
In this module we discuss the evidence for
subacromial impingement syndrome as a
valid clinical diagnosis and where this theory
came from. We also explore the role scapular
dyskinesis plays in shoulder pain causation
and resolution and discuss whether we can
accurately assess scapular kinematics.
1. Understand the influence of scapular
dyskinesis on the development and resolution
of rotator cuff related shoulder pain.
2. Explain the evidence as it relates to the
reliability and validity of visual observation
of scapular kinematics.
3. Explain why subacromial impingement
syndrome is being challenged as a valid
diagnosis of shoulder pain.
Module 3: Structure, posture and surgery
Shoulder structures are commonly blamed for
the onset and persistence of shoulder pain,
however is this borne out in the evidence base?
In this module we discuss posture as it has long
been the target of health care practitioners as
a means of improving shoulder pain, but we
explore if this is an evidence-based approach to
the shoulder. Finally, we discuss surgeries for the
shoulder which have always been thought of as
the gold standard intervention to successfully
manage most shoulder pain conditions, but is
there data to support this?

2 Copyright © Physio Network

Learning objectives:
1. Understand the relationship between
shoulder structures, posture and the
experience of rotator cuff related shoulder
pain.
2. Describe the evidence for subacromial
decompression surgery and rotator cuff
repair surgery vs non-surgical management.
3. Explain when shoulder surgery might be
indicated.
Module 4: Exercise, manual therapy and
diagnostic labels
In this module we discuss a variety of treatment
modalities used by Physiotherapists for shoulder
pain and the evidence behind them. Exercise
therapy is the golden child of non-surgical
management of rotator cuff related shoulder
pain, why? Manual therapy is the black sheep
of physiotherapy, why? What diagnostic label
should attribute to the clinical presentation of
“rotator cuff disease”?
Learning objectives:
1. Explain what the empirical evidence is for the
clinical effectiveness of exercise therapy for
the management of RCRSP
2. Describe why manual therapy or therapeutic
touch may be part of clinical care package for
RCRSP
Module 5: Predictors of clinical outcomes
In this module we discuss prognostic factors for a
patient’s outcome and explore if we can predict
how individual characteristics of a patient will
determine if and how they will respond to
3 Copyright © Physio Network
physiotherapy. We also explore the impact of
both structural and non-structural factors of
the individual and how this can affect clinical
outcomes.
Learning objectives:
1. Describe what factors are associated with
clinical outcomes for RCRSP.
2. Understand the relative contribution of
structural and non-structural factors in
influencing clinical outcomes.
Module 6: The future
In this final module we explore the future of
physiotherapy for the management of RCRSP
and give you practical evidence-based tips for
managing your future shoulder patients within
the Physiotherapy clinic.
Learning objectives:
1. Describe what characteristics of
physiotherapy will rise to prominence in the
future for the management of rotator cuff
related shoulder pain.
2. Understand how future recommendations
might impact your clinical practice moving
forward.
Progress Checklist
1. Review all learning objectives
2. Complete all Masterclass video lectures
3. Take the quiz to test your knowledge
4. Print or save your certificate to record your
professional development.
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5 Copyright © Physio Network
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MODULE 3
1. Barreto, R. P. G., Braman, J. P., Ludewig, P.
M., Ribeiro, L. P., & Camargo, P. R. (2019).
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ings in individuals with unilateral shoulder
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6 Copyright © Physio Network

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Johnston, R. V., Page, C. M., & Buchbinder,
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Surgery and physiotherapy were both
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acute, traumatic rotator cuff tears: a
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and meta-analysis of randomized con-
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trial on the efficacy of arthroscopic rota-
Cuff Disorders: A Systematic Review of Clin-
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ical Practice Guidelines and Semantic Anal-
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yses of Recommendations. Arch Phys Med
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M., Buchbinder, R., Guyatt, G., Vandvik,

7 Copyright © Physio Network

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MODULE 5
1. Jain, N. B., Ayers, G. D., Fan, R., Kuhn, J. E.,
Baumgarten, K., Matzkin, E., & Higgins, L.
D. (2018a). Predictors of Pain and Func-
tional Outcomes After the Nonoperative
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2. Jain, N. B., Ayers, G. D., Fan, R., Kuhn, J. E.,
Baumgarten, K. M., Matzkin, E., & Higgins,
L. D. (2018b). Predictors of pain and func-
tional outcomes after operative treatment
for rotator cuff tears. J Shoulder Elbow
Surg, 27(8), 1393-1400. doi:10.1016/j.
jse.2018.04.016
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MODULE 6
1. Cook, C. E., Denninger, T., Lewis, J., Diener, I.,
& Thigpen, C. (2021). Providing value-based
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