Treatment of shoulder pathologies based on irritability: a case series

Study Design: Case Series. Background: Shoulder pain is a prevalent problem in health care. Traditionally, treatment is based on a pathoanatomical diagnosis determined through the use of special tests. The validity of these special tests is questionable and minimal evidence exists to support these tests to guide treatment. The purpose of this case series is to apply the principles of irritability, proposed by McClure and Michener in the Staged Approach Rehabilitation Classification, to adult patients with varying anatomical diagnoses. Case Description: Three patients diagnosed with different shoulder pathologies by referring physicians were recruited from a physical therapy clinic. Diagnoses included unspecified disorder of synovium and tendon, adhesive capsulitis, and other shoulder lesions. Patients were classified using a system based on stages of irritability. Patients received treatment based on impairments and irritability. Outcomes: Patients were treated for a total of 14-18 visits over a course of 7 to 8 weeks. Primary outcome measures included pain measured by the numeric pain rating scale (NPRS) and disability measured by FOTO (Focus on Therapeutic Outcomes). Pain was reduced to 0/10 in all cases and all patients exceeded their predicted outcome scores on FOTO. Discussion: This case series describes the use of an irritability-based classification system for treatment of adults with varying shoulder diagnoses. The positive outcomes indicate that treatment guided by irritability appeared to be beneficial for conservative treatment of three patients in a physical therapy setting. Further research, including randomized controlled trials, is needed to determine effectiveness in a larger population.