After the anamnesis, the most suspected (48%) hypothesis was subacromial impingement, followed by pain due to cervical or thoracic dysfunctions (14%).
The most commonly applied tests during the physical examination for a suspected impingement were: Neer's sign (73%), Hawkins-Kennedy Test (80%), Empty/ Full Can (85%) and the painful arc (64%). and for a suspected glenohumeral instability: O’Brien's (46%), the Relocation Test (70%), the Appprehension test and the Sulcus sign. Most physiotherapists formulated multiple hypotheses and used several tests in their physical examination.
Although diagnostic ultrasound is expected to lead to a more specific clinical diagnosis, it was only used in 31% of all participants with shoulder complaints. However, the effect of ultrasound on patient recovery remains unknown.
During the baseline treatment programme especially advices (91%), exercise therapy (81%) and mobilisation were most commonly applied. Rather alarming was that 73% of patients with subacromial impingement, who had no or insufficient improvement, still received treatment after 6-12 weeks. And only 60% of patients were recovered after 26 weeks. This means that most patients were not treated according to recommendations from the evidence statement, that requires a referral to the GP when no improvement is seen after 6-12 weeks of physiotherapy.