From the Guidelines
For shoulder pain treatment, gentle stretching and mobilization techniques, including increasing external rotation and abduction, should be the initial approach, as they have been shown to be effective in managing hemiplegic shoulder pain 1. When considering treatment options, it's essential to prioritize techniques that improve range of motion and strengthen the shoulder girdle muscles.
- Active range of motion should be increased gradually in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle 1.
- If there are no contraindications, analgesics such as acetaminophen or ibuprofen can be used for pain relief 1.
- Injections of botulinum toxin into the subscapularis and pectoralis muscles could be used to treat hemiplegic shoulder pain thought to be related to spasticity 1.
- Subacromial corticosteroid injections can be used in patients when pain is thought to be related to injury or inflammation of the subacromial region (rotator cuff or bursa) in the hemiplegic shoulder 1. Additionally, other treatment options such as suprascapular nerve blocks 1 and surgical tenotomy of the pectoralis major, latissimus dorsi, teres major, and subscapularis muscles may be considered for patients with severe hemiplegia and restrictions in shoulder range of motion 1. It's crucial to note that the treatment approach should be individualized, and the healthcare provider should consider the underlying cause of the shoulder pain and the patient's overall condition when making treatment decisions.
- A stepwise approach, starting with gentle stretching and mobilization techniques, and progressing to other treatment options as needed, is likely to be the most effective in managing shoulder pain and improving patient outcomes 1.
From the Research
Treatment Options for Shoulder Pain
- Non-surgical treatment options are available for patients with chronic shoulder pain, including physiotherapy, occupational therapy, and psychology as needed 2
- A multidisciplinary approach to care can optimize treatment outcomes for patients with chronic shoulder pain 2
- Conservative treatment options, such as rest, physiotherapy, pain relief, and glucocorticoid injections, can be effective for mild cases of shoulder pain 3
- Surgical options may be considered for patients who have failed conservative treatment or have specific diagnoses, such as impingement, rotator cuff tear, or osteoarthritis 3
Guidelines for Referral to Specialist Care
- Patients presenting with acute injuries or 'red flag' diagnoses should be urgently referred for specialist care 2
- Referral to an orthopaedic surgeon is recommended for patients who have failed an appropriate course of non-surgical treatment 2
Effectiveness of Conservative Treatment
- Conservative treatment can lead to significant improvements in pain intensity, functional limitation, and perceived change in symptoms for patients with chronic shoulder pain 4
- Long-term outcome is not predicted by hand dominance, clinical history of the shoulder condition, severity of the shoulder problem, or shoulder mechanics 4
- Exercise therapy is a strongly recommended first-line treatment for subacromial shoulder pain, with manual therapy as an additional therapy 5
Comparison of Conservative and Surgical Treatment
- No therapeutic intervention is universally accepted for treating shoulder stiffness, and the most effective management has yet to be defined 6
- The rate of failure after treatment for stiff shoulder is higher in the surgical group than in the conservative group 6
- There is insufficient evidence to establish whether surgical or conservative management is the best choice to manage shoulder stiffness 6