What is the best treatment for a shoulder strain?

Best Treatment for Shoulder Strain

The best treatment for shoulder strain includes physical therapy with stretching and range of motion exercises, acetaminophen or NSAIDs for pain relief, and avoiding activities that aggravate the condition. 1

Initial Management

1. Pain Management:

   • First-line: Acetaminophen (up to 4g/day) 1
   • Second-line: NSAIDs at lowest effective dose for shortest duration if acetaminophen is inadequate 1, 2
     • Ibuprofen (400-800mg every 6-8 hours) has shown better improvement in pain severity and functional activity compared to acetaminophen 2
     • Consider meloxicam (once-daily dosing) or celecoxib (better GI safety profile) if GI concerns exist 1

2. Physical Therapy:

   • Active range of motion exercises should be increased gradually 3
   • Focus on stretching and exercises to improve range of motion, particularly external rotation and abduction 3, 1
   • Eccentric strengthening exercises as symptoms improve 1
   • Avoid overhead pulley exercises as they encourage uncontrolled abduction and may worsen pain 3, 1

3. Activity Modification:

   • Reduce activities that cause pain and overload of the affected tendon 1
   • Progress to sport-specific or activity-specific exercises as symptoms improve 1

Additional Interventions

1. Topical Treatments:

   • Capsaicin cream can be applied 3-4 times daily for minor muscle aches and pains 4
   • Modalities including ice, heat, and soft tissue massage 3, 1

2. For Persistent Pain:

   • Subacromial corticosteroid injections if pain is related to inflammation of the subacromial region 3, 1
   • Intra-articular injections (Triamcinolone) have shown significant effects on pain 3

3. For Muscle Spasms:

   • Methocarbamol can be used as needed for acute muscle spasms, but only for short-term use (7 days) 1

Special Considerations

1. Hemiplegic Shoulder Pain:

   • Protect the hemiplegic limb from trauma and injuries to reduce frequency of shoulder-hand syndrome 3
   • Consider shoulder strapping (sling) to prevent trauma 3
   • Botulinum toxin injections into the subscapularis and pectoralis muscles can be considered for severe hypertonicity 3, 1

2. Complex Regional Pain Syndrome (CRPS):

   • Active, active-assisted, or passive range of motion exercises should be used to prevent CRPS 3
   • An early course of oral corticosteroids (starting at 30–50 mg daily for 3–5 days, then tapering over 1–2 weeks) can reduce swelling and pain 3

Monitoring and Follow-up

• Evaluate pain and function every 2-4 weeks 1
• Consider imaging only if there is suspicion of serious pathology, unsatisfactory response to conservative care, or if imaging would change management 1
• If conservative measures fail after 3-6 months, surgical options may be considered 5

Common Pitfalls to Avoid

1. Overtreatment: Most shoulder strains can be effectively treated conservatively, with only a small proportion requiring surgery 5, 6

2. Inadequate Pain Control: Untreated pain can delay rehabilitation and functional recovery 3

3. Premature Return to Activities: Returning to full activities before adequate healing can lead to recurrence or worsening of the condition 1, 7

4. Overlooking Underlying Conditions: Multiple symptomatic tendons should prompt evaluation for possible rheumatic disease 1

5. Prolonged Immobilization: Forced immobilization should be avoided as it can lead to adhesive capsulitis (frozen shoulder) 1