From the Guidelines
Outpatient treatment for subscapular pain should prioritize non-pharmacologic interventions, including exercise, physical therapy, and heat or ice therapy, as these approaches can effectively reduce pain and improve function without the risks associated with pharmacologic treatments. When considering treatment options, it's essential to note that the provided evidence primarily focuses on low back pain, which may not directly apply to subscapular pain. However, the principles of managing musculoskeletal pain can be somewhat generalized.
Non-Pharmacologic Interventions
- Exercise: Focusing on scapular stabilization exercises, rotator cuff strengthening, and posture correction can be beneficial, as seen in treatments for other musculoskeletal conditions 1.
- Physical Therapy: Should be performed 2-3 times weekly for 4-6 weeks, targeting the specific causes of subscapular pain.
- Heat or Ice Therapy: Applying heat for 15-20 minutes several times daily can help relax muscles, while ice packs applied for 15-20 minutes every 2-3 hours can reduce inflammation.
Pharmacologic Interventions
For persistent pain, over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-800mg every 6-8 hours with food) may be considered for short-term use, based on guidelines for managing low back pain 1. However, the use of these medications should be cautious and under the guidance of a healthcare provider, considering the potential risks and side effects.
Long-Term Management
Addressing ergonomic factors at work and home is crucial for long-term management of subscapular pain, as poor ergonomics can exacerbate or perpetuate the condition. This approach aligns with recommendations for managing chronic low back pain, which emphasize the importance of lifestyle modifications and non-pharmacologic interventions 1.
Given the lack of direct evidence on subscapular pain treatment in the provided studies, the approach should be cautious, prioritizing interventions with a strong evidence base for similar conditions and minimizing the use of pharmacologic treatments when possible, in line with the principles outlined for low back pain management 1.
From the FDA Drug Label
Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout Improvement in patients treated for rheumatoid arthritis was demonstrated by a reduction in joint swelling, a reduction in duration of morning stiffness, a reduction in disease activity as assessed by both the investigator and patient, and by increased mobility as demonstrated by a reduction in walking time In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease Naproxen may be used safely in combination with gold salts and/or corticosteroids
The outpatient treatment options for subscapular pain may include naproxen as it has been shown to be effective in reducing joint pain and inflammation in patients with osteoarthritis and other conditions.
- Key benefits of naproxen include reduction in joint pain or tenderness and improvement in mobility.
- Important considerations include potential gastrointestinal side effects and the need for careful monitoring in patients with a history of bleeding or ulceration. 2
From the Research
Outpatient Treatment Options for Subscapular Pain
Outpatient treatment options for subscapular pain include a variety of approaches, ranging from pharmacologic therapy to physical exercises. The choice of treatment depends on the severity and cause of the pain.
- Pharmacologic Therapy: For acute subscapular pain, pharmacologic management can be tailored to each patient, including a review of treatment expectations and a plan for the time course of prescriptions 3. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain. Topical NSAIDs are recommended for non-low back, musculoskeletal injuries, and have been found to be useful in treating acute musculoskeletal pain syndromes, including strains and sprains 4.
- Physical Exercises: Scapular focused interventions can improve short-term shoulder pain and function in adults with subacromial pain syndrome 5. Exercises that target the scapula, such as those that improve scapular movement and strength, can be beneficial. Additionally, the combination of McKenzie exercises and stabilization exercises has been shown to be effective in reducing neck pain intensity and improving neck disability and cervical range of motion 6.
- Conservative Treatment: For subscapularis tears, conservative treatment may be sufficient, especially in the elderly or those with partial tears 7. However, many subscapularis tears require intervention to address complaints of pain, dysfunction, or both.
Considerations for Treatment
When considering outpatient treatment options for subscapular pain, it is essential to take into account the individual patient's needs and circumstances. This includes:
- Patient History: A review of the patient's medical history, including any previous injuries or conditions that may be contributing to the subscapular pain.
- Treatment Expectations: A discussion of the patient's treatment expectations and a plan for the time course of prescriptions or therapy.
- Potential Risks: An awareness of the potential risks and side effects associated with different treatment options, such as the risks of opioid medications 3.