Shoulder stiffness, a condition characterized by restricted glenohumeral range of motion, has long posed a clinical challenge with diverse risk factors, diagnostic approaches, and treatment options. The absence of a unified consensus on the most effective treatment algorithm prompted the Società Italiana Artroscopia Ginocchio Arto Superiore Sport Cartilagine e Tecnologie Ortopediche (SIAGASCOT) to embark on a national consensus project focused on the conservative and surgical treatment of primary shoulder stiffness. The outcomes of this initiative, conducted from 2020 to 2023, offer a wealth of evidence-based recommendations that could guide the management of this challenging condition not only in Italy but also serve as a global model.
This national consensus, a culmination of efforts from numerous healthcare professionals and scientists, utilized a modified Delphi methodology. The preliminary phases involved a comprehensive literature review and a national survey, identifying areas of contention and controversy in the existing evidence. These discussions led to the formulation of 16 questions that would serve as the foundation for the formal consensus. The participants, including surgeons, radiologists, pain therapists, and physical therapists, were organized into a steering group, literature group, rating group, and peer-review group and their collective goal was to address these 16 crucial questions related to the diagnosis and treatment of primary shoulder stiffness, generating evidence-based recommendations that could guide healthcare professionals in their decision-making.
The literature group, aided by a professional librarian from the University of Milan, conducted an exhaustive search for peer-reviewed articles on PubMed and EMBASE, covering a range of publication types. This search, complemented by manual searches and reference examination, provided a targeted literature set for each of the 16 questions. The steering group, armed with the results of the literature review, answered the 16 questions based on the available evidence and their clinical expertise. These answers were then submitted to the rating group, consisting of 20 Italian professionals specialized in the diagnosis and treatment of shoulder pathologies. Using the Likert scale, these experts scored the statements according to the scientific evidence and their clinical experience. After a meticulous process of revisions and discussions, a consensus was reached, validated through a peer-review group comprising 38 experienced Italian healthcare professionals.
The results of this consensus are a solid ground for evidence-based clinical practice. The recommendations received an average rating of 8.4 out of 9, reflecting a high level of scientific evidence supporting the proposed guidelines. Importantly, none of the 16 statements received a rating below 8, indicating a unanimous consensus among the experts involved. The majority of responses were assessed as Grade A, signifying a substantial availability of scientific evidence to guide treatment. This consensus sets basis for evidence‐based clinical practice in the management of primary SS and can serve as a model for similar initiatives and adaptable guidelines in other European countries and potentially on a global scale.