Abstract
Shoulder disorders are a common musculoskeletal problem causing pain and functional loss. Traditionally, diagnostic categories are based on a pathoanatomic medical model aimed at identifying the pathologic tissues. However, the pathoanatomic model may not provide diagnostic categories that effectively guide treatment decision making in rehabilitation. An expanded classification system is proposed that includes the pathoanatomic diagnosis and a rehabilitation classification based on tissue irritability and identified impairments. For the rehabilitation classification, 3 levels of irritability are proposed and defined, with corresponding strategies guiding intensity of treatment based on the physical stress theory. Common impairments are identified and are used to guide specific intervention tactics with varying levels of intensity. The proposed system is conceptual and needs to be tested for reliability and validity. This classification system may be useful clinically for guiding rehabilitation intervention and provides a potential method of identifying relevant subgroups in future research studies. Although the system was developed for and applied to shoulder disorders, it may be applicable to classification and rehabilitation of musculoskeletal disorders in other body regions.
Footnotes
Both authors provided concept/idea/project design and writing. The authors acknowledge Martin Kelley, Amee Seitz, Mike Shaffer, and Tim Uhl for their input into the early development of the classification system presented. They also acknowledge the helpful input from a group assembled to create the National Orthopaedic Physical Therapy Outcomes Database for the shoulder.
- Received April 14, 2014.
- Accepted November 25, 2014.
- © 2015 American Physical Therapy Association
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