From the Guidelines
Management of right shoulder pain and stiffness typically involves a combination of pain relief, anti-inflammatory measures, and rehabilitation. Initially, rest the shoulder and apply ice for 15-20 minutes several times daily to reduce inflammation, as recommended by various studies on acute shoulder pain 1. Some key considerations in managing right shoulder pain and stiffness include:
- Taking over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (250-500mg twice daily) for pain and inflammation, for up to 1-2 weeks unless contraindicated
- Physical therapy focusing on gentle stretching and range-of-motion exercises, gradually progressing to strengthening, with specific exercises including pendulum stretches, wall walks, and cross-body stretches performed 2-3 times daily
- Considering corticosteroid injections for persistent pain, typically using methylprednisolone (40mg) or triamcinolone (40mg) mixed with lidocaine
- Using heat therapy before exercise to help relax muscles and improve flexibility
- Implementing a structured rehabilitation program lasting 3-6 months for symptoms suggesting frozen shoulder (adhesive capsulitis)
- Considering surgical options like arthroscopic capsular release for severe cases unresponsive to conservative treatment for 3-6 months, as a multimodal approach may be required to accurately assess shoulder pathology 1. These interventions work by reducing inflammation, breaking adhesions, strengthening supporting muscles, and gradually restoring normal shoulder biomechanics.
From the Research
Management of Right Shoulder Pain and Stiffness
- The management of right shoulder pain and stiffness can be achieved through various conservative and surgical interventions 2.
- Conservative management includes nonsteroidal anti-inflammatory medications, corticosteroid injections, transcutaneous electrical nerve stimulation, manipulation under anesthesia, and arthroscopic capsular release 2.
- A study found that patients with chronic shoulder pain, with or without accompanying stiffness, can expect significant decreases in shoulder pain and improvements in shoulder function in the long term after conservative treatment 3.
- Corticosteroid injection therapy and physiotherapy are also effective interventions for managing shoulder pain, with corticosteroid injection showing improvement in shoulder function at 6-7 weeks, but no evidence of superiority over physiotherapy for pain and range of motion in the short term 4.
- Acetaminophen and ibuprofen are commonly used pharmacologic treatments for rotator cuff-related shoulder pain, with ibuprofen showing improvement in pain severity and functional activity, and acetaminophen showing improvement in physical and environmental domains of quality of life 5.
- Handgrip strength exercises have been shown to modulate shoulder pain, function, and strength of rotator cuff muscles in patients with primary subacromial impingement syndrome, with significant improvement in shoulder pain and function, strength of rotator cuff muscles, and pain-free range of motion 6.
Treatment Options
- Conservative treatment:
- Nonsteroidal anti-inflammatory medications
- Corticosteroid injections
- Transcutaneous electrical nerve stimulation
- Manipulation under anesthesia
- Arthroscopic capsular release
- Physiotherapy
- Handgrip strength exercises
- Pharmacologic treatment:
- Acetaminophen
- Ibuprofen
- Surgical intervention:
- Arthroscopic capsular release
Outcome Measurements
- Pain intensity
- Functional limitation
- Perceived change in symptoms
- Active range of motion
- Muscle force
- Clinical and demographic variables
- Shoulder Pain and Disability Index (SPADI)
- Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)
- World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires