From the Guidelines
The recommended initial approach for a patient with bilateral shoulder pain involves considering interventions to prevent further pain and improve range of motion, such as electrical stimulation, shoulder strapping, and staff education to prevent trauma, as suggested by the management of adult stroke rehabilitation care guideline 1. When evaluating a patient with bilateral shoulder pain, it's crucial to consider the potential causes and contributing factors, including overuse, poor posture, or underlying conditions like rotator cuff tendinopathy.
- Key considerations in the workup include:
- Medical history to identify any underlying conditions that may be contributing to the pain
- Physical examination to assess range of motion, strength, and tenderness
- Imaging studies, such as X-rays or MRI, if conservative treatment fails or if there are concerning symptoms
- Treatment options, as outlined in the guideline 1, may include:
- Intra-articular injections, such as Triamcinolone
- Shoulder strapping
- Improving range of motion through stretching and mobilization techniques, focusing on external rotation and abduction
- Modalities like ice, heat, and soft tissue massage
- Functional electrical stimulation (FES)
- Strengthening exercises Given the potential for bilateral shoulder pain to impact quality of life significantly, early initiation of physical therapy and conservative measures is essential, with a focus on gentle stretching, strengthening, and education on proper posture and movement techniques to prevent exacerbation of the condition, as supported by the guideline 1.
From the Research
Bilateral Shoulder Pain Workup
The workup for bilateral shoulder pain involves a combination of physical examination, imaging studies, and diagnostic injections.
- The diagnosis is crucial in decision-making when treating a patient with shoulder pain 2.
- Ultrasound is also very important in the diagnostic and therapeutic pathway, especially when surgery is being considered 2.
- It is essential to correlate the clinical assessment with the imaging signs and treat the patient, not the images, as there may be abnormalities detected on imaging that are not symptomatic 2.
Treatment Options
The treatment options for bilateral shoulder pain include:
- Conservative treatment options such as physical therapy, pharmacological therapy, and biological therapy 3.
- Physical therapy is performed to decrease pain, increase shoulder range of motion (ROM), and protect the glenohumeral joint 3.
- Administration of pharmacological agents, such as non-steroidal anti-inflammatory drugs, is recommended as first-line therapy to reduce pain and inflammation in the joint 3.
- Oral medications, such as non-steroidal anti-inflammatory drugs, can provide patients with transient pain relief 4, 5.
- Intra-articular corticosteroid injection can provide longer-term effects but must be used cautiously in athletes 3.
- Biologics, such as platelet-rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cells, have gathered increased attention, but further evidence is needed to determine their effectiveness 3.
Exercise and Mobility
Exercise is an essential component of the treatment plan for bilateral shoulder pain.