Lack of uniformity in diagnostic labeling of shoulder pain: Time for a different approach

Diagnostic labels for shoulder pain (e.g., frozen shoulder, impingement syndrome) are widely used in international research and clinical practice. However, about 10 years ago it was shown that the criteria to define those labels were not uniform. Since an ongoing lack of uniformity seriously hampers communication and does not serve patients, we decided to evaluate the uniformity in definitions. Therefore, we compared the selection criteria of different randomised controlled trials (RCTs). This comparison revealed uniformity, the currently used labels have only a fair to moderate interobserver reproducibility and in systematic reviews none of the seperate trials using a diagnostic label show a large benefit of treatment. This, altogether, seems sufficient reason to reconsider their use. Therefore, we strongly suggest to abolish the use of these these labels and direct future research towards undivided populations with "general" shoulder pain. Possible subgroups, with a better prognosis and/or treatment result. based on common characteristics that are easily and validly reproducible, can then be identified within these populations. (C) 2008 Elsevier Ltd. All rights reserved.