A structural relationship model of cervicobrachial region for the treatment of shoulder dysfunction: Evidence-Based...

Shoulder problems are among the most common musculoskeletal complaints, with high lifetime incidence and re-occurrence rates. Research is struggling to unravel the relationship between symptomology, local structural changes and experienced pain. This paper explains some such links, exploring the connections between the respiratory system, forward head posture, and nerve compression. The effects of peripheral nerve irritations on pain, reflexive changes, faulty nerve discharges, referred pain, and alteration of muscle recruitment patterns are discussed and suggested to be evidence of a hierarchy existing between the neural and musculoskeletal structures. The content presented is based on clinical experience and a narrative literature review, and it is combined into an evidence-based clinical reasoning model. Challenges in detecting intermittent nerve compressions via different diagnostic tools are also addressed. It is suggested that dynamic and transient nerve compressions during functional movements are often overlooked, as there seems to be no diagnostic tool which can confirm (rule in) nerve involvement when symptoms suggesting nerve involvement are present. Finally, a four-step treatment model for addressing functional relationships between respiration, forward head posture, nerve compressions and motor control impairments is presented. In conclusion, this review argues that prioritising afferent-efferent neuromuscular interconnectedness in treating complex shoulder dysfunction could lead to improved clinical outcomes and lower re-occurrence rates. Experienced clinicians should form clinical reasoning models giving equal value to all three pillars of Evidence-Based Practice (EBP) - combining their experience and patient feedback with the literature. This would lead to patient-centred integration of research and clinical practice, which could help reduce the gap between the academic and clinical worlds.