Tania Pizzari PhD – Practical Lessons in Shoulder Assessment and Management
- Luke Perraton
- 1 day ago
- 3 min read
I recently spoke with Associate Professor Tania Pizzari on the Physio Foundations Podcast about shoulder assessment and management. This episode is very useful for students, grads and any practitioner who wants to develop their expertise in shoulder management. Here are some of the key practical themes that emerged from our conversation.
Use diagnostic categories, but don’t get trapped by them
Tania outlined some broad categories that are genuinely useful for structuring your thinking:
Glenohumeral instability (traumatic or atraumatic)
AC joint pathology
Glenohumeral joint stiffness (OA, frozen shoulder)
Rotator cuff / subacromial pain presentations
Don’t forget the neck as a pain source, contributing factor or innocent bystander
These categories are particularly helpful in acute trauma, and for providing patients, referrers or third parties with an 'answer' for 'what's going on'.
But for atraumatic shoulder pain, and reasoning about physiotherapy management, Tania discussed the benefit of using a movement systems approach. For example:
Do symptoms change with altered scapular position, such as assisted upward rotation?
Is there excessive humeral head translation and does changing this change symptoms?
Does this look more like hypomobility (e.g. frozen shoulder) or hypermobility (e.g. atraumatic instability)?
In our conversation, we did not dismiss the importance of understanding structural problems; however, shifting from “which structure?” to “what happens if I modify movement?” can change the direction of your assessment and rehabilitation.
A key clinical question to consider: Can I change it?
One of the strongest themes was the idea of symptom modification during assessment. Rather than relying on binary positive/negative tests, Tania repeatedly comes back to....
'Can I change their symptoms right now?'
Examples we discussed:
Assisting scapular upward rotation for limited glenohumeral flexion
Reducing posterior humeral head translation during resisted testing
Repositioning the scapula to alter strength
Using taping to modify symptoms during functional tasks
If symptoms change with manual correction or cueing, you gain:
A clearer rehabilitation direction
Early patient confidence
Patients often want more than a label. Demonstrating change during assessment can be more powerful than naming a structure.
Rotator cuff tests as clinical reasoning tools - not just diagnostic validity
Rotator cuff tests still have clinical value, but perhaps not always as definitive diagnostic labels. Instead of over-interpreting individual tests, consider:
Does this load provoke symptoms?
Does scapular repositioning change pain or strength?
Does humeral head stabilisation alter output?
Tests become part of your reasoning process, rather than endpoints.
4. Education begins during the assessment
Another practical theme was that education does not start at the end of the consult.
It begins when you:
Show how movement changes symptoms
Explain what you are modifying and why
Involve the patient in the reasoning process
Linking assessment findings directly to rehabilitation direction builds confidence and clarity.
5. Challenging presentations still exist
Even with years of experience, Tania acknowledged the complexity of certain cases:
Chronic neck and shoulder overlap
Metabolic and postmenopausal influences
Persistent upper limb tendon pain
Central sensitisation
Upper limb pain is difficult because complete rest is rarely possible. That ongoing load can complicate recovery.
Final message
Tania’s closing advice was simple: You can always learn more.
Expertise in shoulder management is not about memorising more information. It’s about better reasoning, clearer prioritisation and continual refinement of your thinking.
If you work with shoulder pain, I hope these themes are useful.
Also available on our YouTube channel.
