Using Certain Terms Can Make Patients More Likely To Think Surgery Is Needed For Shoulder Pain
Here’s what a common PT CEUs course will go over: the rotator cuff connects the upper arm bone (humerus) to the shoulder blade (scapula) with four muscles, each of which has a tendon that attaches to different parts of the scapula. These tendons form a “cuff” around the head of the humerus, and all the muscles work together to control and stabilize the shoulder. As a ball-and-socket joint, the rotator cuff helps secure the “ball” portion of the joint—the humerus—as the arm moves and rotates within the “socket” (the scapula). It plays an extremely important role in keeping the shoulder stable when performing many overhead movements (eg, reaching, throwing, and picking up items), but because the rotator cuff is used so frequently, it’s also extremely vulnerable to injury.
There’s nothing wrong with this – we all need a review and foundational information. But read on to learn more about something we often miss at PTs…and our PT CEUs course can teach you.
You’ll Be Surprised What You May NOT Know When It Comes to Treating the Shoulder…and What We Can Teach You
“Rotator cuff disease” is an umbrella term used to describe all disorders that involve the rotator cuff, including rotator cuff tears, bursitis, subacromial impingement syndrome, and rotator-cuff related shoulder pain. But research has shown that using certain diagnostic terms and labels can influence patients’ treatment preferences.
For example, two surgical procedures—subacromial decompression surgery and rotator cuff repair—are frequently performed to treat rotator cuff disease despite current evidence indicating that these procedures are no better than placebo or nonsurgical treatment.
It’s possible that patients who are diagnosed with subacromial impingement syndrome and told that their pain is caused by a bone spur that is reducing the subacromial space may believe surgery is needed to fix the issue, when other language might lead to a different opinion.
You Were Taught Some of This Stuff in School, but Arguably, Some of the Most Important Care Comes from the Language You Use
Researchers therefore conducted a study to determine if different diagnostic labels for rotator cuff disease influence patients’ perceived need for surgery. Patients were recruited from five countries and asked to participate, which led to more than 1,600 participants being included in the study. All participants were first instructed to read a standardized vignette about hypothetical shoulder pain that was written in an optimistic style, free of language that could potentially induce fear, and designed to imply that their symptoms would eventually improve. After reading the vignette, participants were randomized to 1 of 6 diagnostic labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator cuff-related shoulder pain, shoulder sprain, episode of shoulder pain. They were then asked to rate their perceived need for surgery, imaging, an injection, a second opinion, and to see a specialist after being given one of these diagnostic labels.
UPDATE – December 27th, 2022 – we wrote a detailed, additional post about the importance of communication – click here to read that and learn how you can get some PT CEUs if you attend our shoulder course.
Changing Your Approach to Communication Can Save Patients Money, Time, & Reduce Risk
Overall, participants in all groups assessed their perceived need for surgery as low, but there was some variation between groups. Participants who were given a rotator cuff tear diagnosis had the highest perceived need for surgery when compared to those who were given a bursitis diagnosis. The perceived need for imaging was moderate across all groups, but highest in participants who in the rotator cuff tear and subacromial impingement groups compared to the bursitis group, and there were no differences between groups for all other outcomes.
These findings suggest that using certain diagnostic terms for rotator cuff disease can indeed impact individuals’ perceived need for surgery and imaging tests.
The terms “rotator cuff tear” and “subacromial impingement syndrome” appear to make individuals more likely to believe surgery and/or imaging is required, while “bursitis” and “shoulder sprain” appear to be associated with a lower perceived need for these interventions.
Since these terms can be used interchangeably, healthcare providers should be more careful when determining how to deliver a diagnosis to patients, as doing so may help to lower the rates of unnecessary surgical procedures and imaging tests.
We Have a Shoulder Physical Therapy Con Ed Course That will Teach You This and So Much More!
At Applied Continuing Education (ACE), we focus heavily on the importance of clear communication with patients and carefully choosing the best diagnostic terms in our two physical therapy continuing education courses (“Weight Management for Rehab Patients” and “Shoulder Pain and Dysfunction”).
If you want to improve your communication skills and are interested in learning more about our courses, review the ACE website to see if the courses align with your needs and values.