Conservative therapy of the shoulder and elbow

Many shoulder and elbow conditions do not require surgery. The aim of the current study was to map the current practice in conservative treatment of shoulder and elbow conditions in the German, Austrian, and Swiss Shoulder and Elbow Society (DVSE) and to identify the need for continuing education in these treatments.

All DVSE members who are healthcare professionals were invited by email to voluntarily participate in an anonymous online survey (April to May 2023) for this cross-sectional observational study. Full and partial interviews were included in the statistical analysis.

The overall rate of completed interviews was 13.2% (n = 156). Almost all responding physicians are surgeons (98.7%), but they also use conservative treatments for shoulder and elbow conditions (96.7%). The most commonly used or prescribed conservative treatments are oral nonsteroidal anti-inflammatory drugs (NSAIDs, 80.7%), manual therapy (64.3%), local infiltrations (62.1%), and exercise therapy (60.0%). The most commonly used infiltrations are local anesthetics, crystalloid glucocorticoids, and platelet-rich plasma (PRP). A large proportion also prescribe braces, while modern digital health applications for home exercise have barely been prescribed. Most members are interested in electromyography biofeedback training (46.1%) and infiltrations with autologous blood derivatives (37.5%).

The DVSE physicians primarily use evidence-based conservative treatments such as oral NSAIDs, physical therapy, local infiltrations (especially crystalloid glucocorticoids and PRP) for shoulder and elbow conditions. There is particular interest in modern device-based treatments and infiltrations with autologous blood derivatives, which should be considered in future educational planning.