From the Guidelines
The recommended treatment for degenerative shoulder and AC joint changes with subacromial narrowing typically begins with conservative measures. Start with a combination of rest, activity modification to avoid overhead movements, and application of ice for 15-20 minutes several times daily to reduce inflammation. Take non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for 2-3 weeks to manage pain and inflammation, as suggested by 1. Physical therapy focusing on rotator cuff strengthening, scapular stabilization, and proper shoulder mechanics should be pursued for 6-8 weeks, with 2-3 sessions weekly.
- Key aspects of physical therapy include:
- Rotator cuff strengthening exercises
- Scapular stabilization techniques
- Proper shoulder mechanics training If these measures fail to provide relief, a subacromial corticosteroid injection (typically methylprednisolone 40mg mixed with lidocaine) may be administered, as supported by 1. For persistent symptoms, surgical options including arthroscopic subacromial decompression, AC joint resection, or in advanced cases, shoulder arthroplasty may be considered, as mentioned in 1. These treatments work by reducing inflammation, strengthening supporting musculature, increasing joint space, and correcting biomechanical issues that contribute to impingement. The staged approach allows most patients to achieve symptom relief without requiring invasive procedures.
From the Research
Degenerative Changes in the Shoulder Joint and AC Joint
- Degenerative changes in the shoulder joint and AC joint can lead to relative narrowing of the subacromial space, potentially causing impingement 2, 3, 4.
- The subacromial impingement syndrome (SAIS) is a common cause of shoulder pain, and its management can be challenging 2.
Clinical Correlation to Rule Out Impingement
- A thorough clinical evaluation is necessary to rule out impingement, including a physical examination and imaging studies 5.
- The type of subacromial lesion needs to be considered, as it may offer an explanation for the difference in severity of symptoms and response to treatment 2.
Recommended Treatment
- Conservative management, including physical therapy and exercise, is often the first line of treatment for SAIS 3, 4, 6.
- Platelet-rich plasma (PRP) injection and corticosteroid injection may also be effective in reducing pain and improving shoulder function 3.
- Surgical decompression may be considered in some cases, but the evidence is limited, and further studies are needed to determine its effectiveness 2.
- Manual physical therapy has been shown to be effective in improving shoulder function and reducing pain, with fewer adverse events compared to corticosteroid injections 6.
Treatment Options
- Physiotherapy, including exercise therapy, mobilization, and hyperthermia, may be effective in treating SAIS 4.
- The choice of treatment should be based on the individual patient's needs and the severity of their symptoms 5.
- A multidisciplinary approach, including physical therapy, orthopedic evaluation, and pain management, may be necessary to effectively manage degenerative changes in the shoulder joint and AC joint 5.