Med Biol Eng Comput - Communication breakdown: clinicians disagree on subacromial impingement.


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Subacromial impingement syndrome (SIS) is often used as a diagnostic label, but has become more controversial as such in the literature. We assessed views on SIS in clinical practice using a survey with 63 0-10 VAS items among orthopedic surgeons and physical therapists from the United States and the Netherlands. Multivariate regression and cluster analyses were applied to identify consensus items and to study profession and/or nationality effects on item ratings. Most items received neutral or highly variable ratings. Twenty-nine were considered associated with SIS, including worsening of pain with overhead activities, painful arc and a positive Neer's test. Seven items were regarded pleading against SIS, including loss of passive motion. Activity modifications and physical therapy are the most important treatments according to therapists, who highly valued motion-related etiologic mechanisms. Surgeons, with higher ratings for intrinsic and anatomic etiologies, appreciated the use of subacromial corticosteroids and surgery. Clinicians from different professional backgrounds have different views on what SIS is, and even within professional groups, variations are substantial. This has to be taken into account when communicating about SIS symptoms, for example, in intercollegial consultation or scientific research. The authors suggest cautious use of (subacromial) impingement syndrome as a diagnostic label.

Resumo Limpo

subacromi imping syndrom sis often use diagnost label becom controversi literatur assess view sis clinic practic use survey vas item among orthoped surgeon physic therapist unit state netherland multivari regress cluster analys appli identifi consensus item studi profess andor nation effect item rate item receiv neutral high variabl rate twentynin consid associ sis includ worsen pain overhead activ pain arc posit neer test seven item regard plead sis includ loss passiv motion activ modif physic therapi import treatment accord therapist high valu motionrel etiolog mechan surgeon higher rate intrins anatom etiolog appreci use subacromi corticosteroid surgeri clinician differ profession background differ view sis even within profession group variat substanti taken account communic sis symptom exampl intercollegi consult scientif research author suggest cautious use subacromi imping syndrom diagnost label

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