Aims and Objectives: The aim of this study is to undertake a clinical audit of presenting shoulder injuries to the Defence Forces Physiotherapy Service during its first ten months of existence.
Objectives of this audit are:
- To identify any emerging patterns that could help inform future practice.
- To hypothesise injury prevention methods to reduce the incidence of shoulder injuries presenting to the DF Physio service.
Methods:
A clinical audit of gender, age, corps, pain (0-10), function (0-10), status (0-100), mechanism of injury, duration of injury and diagnosis was carried out using the Socrates programme used by the medical professionals in the Defence Forces.
Data on tight, weak and shortened muscles as assessed by the team of six physiotherapists was also correlated using the same programme.
Results:
Only 8% of injuries presenting were female. Infantry largest population attending physio with shoulder injuries. 56% of those injured were between 19-40 years of age. 43% of injuries were caused by lifting, a repetitive strain injury or a fall. 22% had a cause that was either unknown or idiopathic. Non occupational injuries were more common than occupational ones in a ratio of 2:1. Almost two thirds of patients were diagnosed with a muscle or tendon strain or trigger point pathology. Over 35% of patients had an injury for over three months before seeking treatment. The majority of patients who presented with shoulder pain also had shortened pectoral muscles, and trigger points in the Upper Trapezius and Infraspinatus.
Conclusion:
With the large proportion of injuries lifting related should there be more education about and monitoring of techniques in gym and focus on improving ergonomic practices. With over 60% injuries in a muscle or tendon this points to overuse which again points management towards education and instruction in training daily.
Many patients had injuries for a sustained period prior to seeking physiotherapy intervention. This could be to two reasons. Firstly, we may need to reduce fear element associated with having an injury or need to increase education about it being easy to rehab injury that are recent rather than ‘letting them go’. Secondly, at present physiotherapists are not first point practitioners in the defence forces and some patients are reluctant to attend the doctor on site. This is something that could be looked at being modified in the future. TrP treatment in shoulder pain is four times more likely to improve conditions than a ‘wait and see approach’ (Bron et al 2011). As a service, we may need to link in more with instructors and gym staff to encourage more self TrP release (balls, foam rollers etc.) and stretching (especially Pectorals) as part of training to reduce incidence of shoulder injuries presenting. The kinetic chain should be kept in mind when thinking of shoulder injuries presenting to the DF physio service. A weak Serratus Anterior, tight Pectorals and Trapezius could predispose to lumbar pathology at a later stage, as per Janda’s Upper and Lower Crossed Syndrome, leading to a longer period of not being fully operational (Janda 1987). Modifying training could prevent some of this.
