1. Clinical Diagnosis & Assessment
- F
Comprehensive History: Assess reason for consultation, sport/work demands, and psychosocial factors.
- B
Physical Assessment: Diagnosis should be based on a cluster of findings including Inspection, ROM, and Strength testing.
- B
Special Tests: Use tests (like Painful Arc) as supportive rather than definitive; no single test is diagnostic in isolation.
Imaging Recommendation:
"Prescribe imaging only if symptoms fail to improve or resolve within a maximum of 12 weeks of appropriate nonsurgical management."
2. Medical Management
NSAIDs
Short-term pain relief only (oral or topical).
CSI Injections
Short-term relief; NOT first-line. Prefer US-guided.
Regenerative Med
PRP/Stem Cells have insufficient evidence for long-term benefit.
3. Rehabilitation Pillars
Active Exercise Therapy
The primary management strategy. Focus on progressive loading, motor control, and functional strengthening tailored to goals.
Patient Education
Address load tolerance, pain neuroscience, and self-management to empower patient-led recovery.
Manual Therapy
An adjunct for short-term pain reduction. Must be integrated with an active exercise program.
Return to Function & Sport
Guidelines emphasize PROBABILISTIC PROGRESSION. Clinicians must ensure tissue capacity meets functional demand.
1. Pain Monitoring Model
"Pain is acceptable during load if it remains ≤ 4/10 and resolves within 24 hours."
- • Zero increase in night pain.
- • Morning stiffness returns to baseline.
2. Load Capacity
"Progression to high-load eccentric and sport-specific plyometrics."
- • Tolerates ≥ 3 sets of heavy resistance.
- • Asymptomatic through full kinetic chain tasks.
3. Psychological Readiness
"Assessment of fear-avoidance (TSK-11) and self-efficacy."
- • Low kinesiophobia scores.
- • High confidence in limb protection during collision.
4. Functional Symmetry
"Limb Symmetry Index (LSI) as a clinical prerequisite."
- • LSI ≥ 90% in isometric external rotation.
- • ROM symmetry in GIRD/Functional Reach.
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