From the Guidelines
Treatment for shoulder injuries should be individualized based on the type and severity of the injury, with a focus on conservative management for soft-tissue injuries and acute surgical treatment for unstable or significantly displaced fractures, as recommended by the American College of Radiology 1. The various types of treatment for shoulder injuries can be categorized into conservative management and surgical interventions.
Conservative Management
Conservative management is often recommended for minor shoulder injuries, including:
- The RICE protocol (Rest, Ice, Compression, and Elevation) as initial treatment
- Over-the-counter pain medications like acetaminophen (Tylenol) at 500-1000mg every 6 hours or NSAIDs such as ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours for pain and inflammation
- Physical therapy to improve range of motion, strength, and stability over 6-12 weeks with 2-3 sessions per week
- Corticosteroid injections like methylprednisolone (40-80mg) or triamcinolone (20-40mg) directly into the shoulder joint to reduce inflammation, as supported by studies on hemiplegic shoulder pain 1
- Platelet-rich plasma (PRP) injections for tendon injuries, requiring 1-3 treatments spaced 4-6 weeks apart
Surgical Interventions
Surgical interventions become necessary for:
- Complete rotator cuff tears
- Recurrent dislocations
- Severe fractures Options for surgical interventions include:
- Arthroscopic repair
- Open surgery
- Shoulder replacement Recovery from shoulder surgery typically takes 3-6 months and requires dedicated post-operative rehabilitation. Some key points to consider when treating shoulder injuries include:
- Accurate diagnosis of the specific injury is crucial to determine the appropriate treatment approach
- Different structures in the shoulder (rotator cuff, labrum, bursa, or glenohumeral joint) require targeted interventions for optimal healing and return to function
- The treatment approach should prioritize minimizing morbidity, mortality, and improving quality of life, as supported by the American College of Radiology 1 and the American Heart Association/American Stroke Association 1.
From the Research
Types of Treatment for Shoulder Injuries
- Conservative management: includes pain management, short-term use of a sling for comfort, and physical therapy as needed 2
- Corticosteroid injections: effective for improving the recovery of range of motion (ROM) and pain in various conditions of the shoulder, including rotator cuff repair 3 and rotator cuff impingement syndrome 4
- Platelet-rich plasma (PRP) injections: a safe treatment and can be a useful tool in the therapeutic arsenal against rotator cuff diseases, with similar results to corticosteroids in most clinical aspects 4, 5
- Surgical treatment: includes reduction maneuvers for glenohumeral dislocations, and arthroscopic capsular release for shoulder stiffness 2, 6
- Physical therapy: important for improving range of motion and strength, especially after conservative or surgical treatment 2, 6
Specific Treatments for Common Shoulder Injuries
- Acromioclavicular joint injuries: conservative management with pain management, short-term use of a sling, and physical therapy as needed 2
- Clavicle fractures: conservative management with pain management, short-term use of a sling, and physical therapy as needed 2
- Glenohumeral dislocations: reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia 2
- Proximal humerus fractures: conservative management with a sling, early range-of-motion exercises, and strength training 2
- Rotator cuff tears: treatment options include corticosteroid injections, PRP injections, and surgical repair 3, 4, 5
- Shoulder stiffness: treatment options include conservative means such as nonsteroidal anti-inflammatory medications, corticosteroid injections, and transcutaneous electrical nerve stimulation, as well as surgical options like arthroscopic capsular release 6