Review was overly negative

EDITOR—The systematic review by Green and colleagues of interventions for treating shoulder pain concluded that there is little evidence to support the use of any of the common interventions for the management of shoulder pain.1 This is a negative message that is likely to inhibit practitioners from treating patients with shoulder pain and to dissuade them from referring these patients to specialists. While we agree with the other conclusions of the study, we disagree with the negative message about treatment for several reasons.

Rheumatologists make decisions about the treatment of musculoskeletal disorders such as shoulder pain based on the duration of the condition, its severity, and a careful examination to define the exact site of the lesion.2 It is generally taught, for example, that the injection of corticosteroids will only work if done soon after the onset of any shoulder disorder and if the injection has been precisely localised to the anatomical site of the problem, such as a specific tendon or bursa within the rotator cuff.3 In the systematic review of the evidence great weight was given …