Abstract：
To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders.
A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases.
Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included.
CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into \"recommended,\" \"may be recommended,\" or \"not recommended.\" Disagreements were resolved by discussion until reviewers reached consensus.
Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient\'s history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it.
Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.
A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases.
Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included.
CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into \"recommended,\" \"may be recommended,\" or \"not recommended.\" Disagreements were resolved by discussion until reviewers reached consensus.
Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient\'s history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it.
Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.
摘要：
目的：对涵盖常见肩关节疾病管理的临床实践指南（CPGs）进行系统评价。
方法：截至2022年8月，在相关数据库中对特定肩部疾病的CPG进行了系统搜索。
方法：二十六个CPG治疗肩袖（RC）肌腱病，RC撕裂,钙化性肌腱炎,粘连性囊炎,肱骨（GH）不稳定，筛选并纳入2008年1月以来发表的GH骨关节炎或肩锁疾病。
方法：使用AGREEII核对表评估CPGs方法学质量。来自CPG的所有建议均按肩部疾病和护理成分进行提取和分类(评估，诊断成像,medical,康复和手术治疗)。在对术语进行语义分析之后，每种肩部疾病的建议由两名评审员分类为：“推荐，可能建议\"或不建议\"。“分歧通过讨论解决，直到审稿人达成共识。
结果：只有12个CPG（46％）是高质量的，主要限制与指南的适用性和编辑独立性有关。肩痛的初步评估应包括患者的病史，主观评价侧重于红旗和临床检查。MRI通常不推荐用于治疗早期肩痛，和X射线的建议是相互矛盾的。对乙酰氨基酚,推荐或可能推荐口服非甾体类抗炎药和包括运动在内的康复治疗来治疗所有肩痛疾病.关于手术管理建议的指南有所不同；例如，六个CPG报告在慢性RC肌腱病中推荐或可能推荐肩峰成形术，而四个CPG不推荐。
结论：诊断影像学的建议各不相同，保守治疗与手术治疗肩痛，虽然几个护理组件是自愿的。基于证据的发展，严格的CPG,有效的方法和透明的报告是必要的,以改善整体肩痛护理.
方法：截至2022年8月，在相关数据库中对特定肩部疾病的CPG进行了系统搜索。
方法：二十六个CPG治疗肩袖（RC）肌腱病，RC撕裂,钙化性肌腱炎,粘连性囊炎,肱骨（GH）不稳定，筛选并纳入2008年1月以来发表的GH骨关节炎或肩锁疾病。
方法：使用AGREEII核对表评估CPGs方法学质量。来自CPG的所有建议均按肩部疾病和护理成分进行提取和分类(评估，诊断成像,medical,康复和手术治疗)。在对术语进行语义分析之后，每种肩部疾病的建议由两名评审员分类为：“推荐，可能建议\"或不建议\"。“分歧通过讨论解决，直到审稿人达成共识。
结果：只有12个CPG（46％）是高质量的，主要限制与指南的适用性和编辑独立性有关。肩痛的初步评估应包括患者的病史，主观评价侧重于红旗和临床检查。MRI通常不推荐用于治疗早期肩痛，和X射线的建议是相互矛盾的。对乙酰氨基酚,推荐或可能推荐口服非甾体类抗炎药和包括运动在内的康复治疗来治疗所有肩痛疾病.关于手术管理建议的指南有所不同；例如，六个CPG报告在慢性RC肌腱病中推荐或可能推荐肩峰成形术，而四个CPG不推荐。
结论：诊断影像学的建议各不相同，保守治疗与手术治疗肩痛，虽然几个护理组件是自愿的。基于证据的发展，严格的CPG,有效的方法和透明的报告是必要的,以改善整体肩痛护理.
