From the Guidelines
For a 36-year-old female with severe right shoulder pain (10/10) during abduction, I recommend initiating treatment with a subacromial corticosteroid injection, such as methylprednisolone 40mg with lidocaine 1%, as moderate evidence supports its use for short-term improvement in both pain and function for patients with shoulder pain 1. This approach is based on the most recent and highest quality study available, which suggests that corticosteroid injections can provide significant relief for patients with shoulder pain. The patient's presentation suggests possible rotator cuff tendinopathy, subacromial impingement, or adhesive capsulitis, and the severe pain with abduction is characteristic of subacromial pathology where the rotator cuff tendons become compressed between the humeral head and acromion during arm elevation. Some key points to consider in the treatment plan include:
- Rest and activity modification to avoid painful movements
- Use of NSAIDs, such as ibuprofen 400-600mg three times daily with food, for 1-2 weeks to reduce inflammation and pain
- Application of ice for 15-20 minutes every 2-3 hours for the first 48-72 hours, then transition to heat therapy
- Prompt initiation of physical therapy, focusing on gentle range of motion exercises, followed by strengthening of the rotator cuff and scapular stabilizers If symptoms don't improve within 4-6 weeks of conservative management, imaging (ultrasound or MRI) should be obtained to evaluate for rotator cuff tears or other structural abnormalities requiring surgical intervention, and considerations for surgical approaches, such as arthroscopic rotator cuff repair, and postoperative pain management strategies, including systemic analgesia and regional analgesic techniques, like interscalene brachial plexus blockade, should be taken into account 1.
From the FDA Drug Label
Use temporarily relieves minor pain The FDA drug label does not answer the question.
From the Research
Therapeutic Outcome for Shoulder Pain
The patient's condition of right-sided shoulder pain with an inability to abduct the arm without severe pain can be addressed through various therapeutic approaches.
- The management of rotator cuff-related shoulder pain can involve pharmacologic treatment, including acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 2.
- A study comparing the efficacy of acetaminophen and ibuprofen found that patients receiving ibuprofen reported improvement in pain severity and functional activity, while those taking acetaminophen reported improvement in the physical and environmental domains of quality of life scores 2.
- For rotator cuff injuries, intra-articular injection therapy is a common conservative treatment, with options including steroid injections, platelet-rich plasma injection therapy, hyaluronic acid injection therapy, and prolotherapy 3.
- A network meta-analysis found that corticosteroid injections combined with hyaluronic acid injections can be effective for the non-surgical conservative management of rotator cuff injuries 3.
- Corticosteroid injections may have a short-term benefit over local anaesthetic injections alone in the management of rotator cuff-related shoulder pain, although there is no evidence to suggest a benefit beyond 8 weeks 4.
Diagnostic Approach
Diagnosis is crucial in decision-making when treating a patient with shoulder pain.
- A diagnostic pathway using the patient's history, physical examination, and ultrasound examination can help identify the underlying cause of shoulder pain 5.
- Ultrasound is important in the diagnostic and therapeutic pathway, especially when surgery is being considered, and can guide treatments such as steroid injections and hydrodilatation 5.
Treatment Options
Treatment options for shoulder pain depend on the underlying cause and may include:
- Pain management and short-term use of a sling for comfort 6.
- Physical therapy as needed 6.
- Intra-articular injection therapy, including steroid injections, platelet-rich plasma injection therapy, hyaluronic acid injection therapy, and prolotherapy 3.
- Surgical intervention may be necessary in some cases, such as for certain types of fractures or rotator cuff tears 6.