Physiotherapeutische Untersuchung und Behandlung von Muskel-Sehnen-assoziierten Schulterschmerzen

Zusammenfassung

Hintergrund

Seit November 2024 können verschiedene Schulterdiagnosen auf der Basis der Blankoverordnung behandelt werden. Physiotherapeut*innen können die Art des Heilmittels und die Frequenz frei wählen. Dafür wären geeignete Praxisleitlinien hilfreich, um diesen Prozess transparenter zu gestalten und einen Entscheidungskorridor zu bieten. Leitlinien der Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF) geben zwar Handlungsanweisungen bezüglich empfohlener und nicht empfohlener Maßnahmen, äußern sich aber weder zur physiotherapeutischen Untersuchung noch zu genauen Parametern für die Behandlung.

Ziel

Untersuchung der Fragestellung: Welche Handlungsempfehlungen ergeben sich für die physiotherapeutische Untersuchung und Behandlung von Patient*innen mit Schulterbeschwerden?

Methode

Um eine Grundlage für die Entwicklung einer deutschsprachigen physiotherapeutischen Praxisleitlinie zu schaffen, wurden von einem Team aus klinisch und wissenschaftlich tätigen Physiotherapeut*innen englischsprachige Praxisleitlinien zu Muskel-Sehnen-assoziierten Schulterschmerzen übersetzt, zusammengefasst und kommentiert. Textpassagen und Empfehlungen aus der Literatur wurden von jeweils mindestens 2 Personen pro Leitlinie in ein gemeinsames Dokument überführt und in 4 Konsensuskonferenzen zusammengeführt und auf Aktualisierungsbedarf überprüft.

Ergebnisse

Es wurden 8 internationale Leitlinien analysiert. Dabei wurden für die Anamnese und körperliche Untersuchung folgende Ziele identifiziert: (1) Erkennen von Red Flags, (2) Erkennen von klinischen Mustern und Abgrenzung verschiedener Schulterpathologien, (3) Einschätzung der Beeinträchtigung auf Funktions- und Partizipationsebene und (4) Auswahl der ersten Behandlung. Für die Behandlung ergaben sich die folgenden physiotherapeutischen Ziele: (1) Minimierung von Schmerzen und Reduktion akuter Entzündungszeichen, (2) Verbesserung der Beweglichkeit, Kraft, Stabilität und der Körperhaltung, (3) Förderung des Selbstmanagements, (4) Reduktion von psychosozialen Risikofaktoren und Förderung der Partizipation. Zu diesen Zielen wurden aus der Literatur Empfehlungen abgeleitet oder bei fehlenden Informationen auf eine Evidenzlücke hingewiesen.

Schlussfolgerungen

Die Ergebnisse dieser Arbeit dienen als Darstellung der aktuellen Evidenz zu internationalen Praxisleitlinien, als Grundlage für systematische Übersichtsarbeiten zu den identifizierten Themen, die dann die Erstellung einer Praxisleitlinie ermöglichen.

Abstract

Background

Since November 2024, various shoulder diagnoses can be treated on the basis of a “blank prescription”. Physiotherapists are free to choose the type of treatment and frequency. Suitable practice guidelines would be helpful here to make this process more transparent and provide a decision-making corridor. Although guidelines from the Association of Scientific Medical Societies in Germany (AWMF) provide instructions regarding recommended and non-recommended measures, they do not comment on the physiotherapy examination or the exact parameters for treatment.

Aim

To evaluate the question: What recommendations can be made for the physiotherapeutic examination and treatment of patients with shoulder complaints?

Method

In order to create a basis for the development of a German-language physiotherapy practice guideline, a team of clinically and scientifically active physiotherapists translated, summarised and commented on English-language practice guidelines on muscle-tendon-associated shoulder pain. Text passages and recommendations from the literature were transferred into a joint document by at least 2 people per guideline and summarised in 4 consensus conferences and reviewed for the need for updates.

Results

Eight international guidelines were analysed. The following objectives were identified for the medical history and physical examination: (1) recognition of red flags, (2) recognition of clinical patterns and differentiation of various shoulder pathologies, (3) assessment of impairment at the functional and participation level and (4) selection of initial treatment. The following physiotherapy goals were set for the treatment: (1) minimisation of pain and reduction of acute signs of inflammation, (2) improvement of mobility, strength, stability and posture, (3) promotion of self-management, (4) reduction of psychosocial risk factors and promotion of participation. For these objectives, recommendations were derived from the literature or, in the absence of information, a gap in the evidence was pointed out.

Conclusions

The results of this study serve as a presentation of the current evidence on international practice guidelines, as a basis for systematic reviews on the identified topics, which in turn enable the creation of a practice guideline.

Schlüsselwörter

Schulterschmerzen - Rotatorenmanschette - Praxisleitlinie - Physiotherapie - Impingementsyndrom

Key words

shoulder pain - rotator cuff - practice guideline - physiotherapy - impingement syndrome

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