What is the initial treatment for right shoulder pain?

Initial Treatment for Right Shoulder Pain

The initial treatment for right shoulder pain should include rest, physical therapy with gentle stretching and mobilization techniques, and NSAIDs such as ibuprofen (400mg every 4-6 hours as needed) for pain relief. 1, 2

Diagnostic Assessment

Before initiating treatment, proper assessment is essential:

• Imaging: Plain radiography is the preferred initial study for shoulder pain, especially if trauma is involved

  • Standard views should include anteroposterior (AP) views in internal and external rotation, and an axillary or scapula-Y view 3
  • Radiography should be performed upright as malalignment can be underrepresented on supine imaging 3

• Clinical evaluation should include:

  • Musculoskeletal assessment
  • Evaluation of spasticity
  • Identification of any subluxation
  • Testing for regional sensory changes 3

First-Line Treatment Approach

1. Physical Therapy:

   • Gentle stretching and mobilization techniques focusing on external rotation and abduction 1
   • Avoid overhead pulley exercises to prevent exacerbation of impingement symptoms 1
   • Progressive strengthening of shoulder girdle muscles 1
   • Early intervention is crucial to prevent permanent dysfunction 1
   • Avoid shoulder immobilization with arm slings or wraps as it can lead to frozen shoulder 1

2. Medication Management:

   • NSAIDs (ibuprofen 400mg every 4-6 hours as needed) for pain relief 2, 1
   • Use the lowest effective dose for the shortest duration to minimize side effects 2
   • Take with meals or milk if gastrointestinal complaints occur 2

3. Patient Education:

   • Proper positioning and range of motion exercises 3
   • Activity modification to avoid aggravating movements 4

Second-Line Interventions (if first-line treatment fails)

1. Corticosteroid Injections:

   • Subacromial corticosteroid injection for shoulder impingement syndrome 1
   • Methylprednisolone acetate 40mg with lidocaine 1% provides rapid pain relief 1
   • Intra-articular injections (triamcinolone) for significant pain 1

2. Advanced Physical Therapy:

   • Eccentric strengthening exercises combined with thermal therapy 1
   • Functional exercises to restore normal movement patterns 1

3. Alternative Interventions:

   • Suprascapular nerve blocks for refractory cases 3, 1
   • Neuromuscular electrical stimulation (NMES) may be considered for shoulder pain 3

When to Consider Surgical Referral

• If conservative management fails after 3-6 months 1, 5
• Surgical options depend on specific diagnosis:
  • Arthroscopic subacromial decompression for impingement
  • Rotator cuff repair
  • Shoulder arthroplasty for advanced osteoarthritis 1, 5

Treatment Outcomes

Approximately 80% of patients recover completely within 3-6 months with appropriate conservative treatment 1. Early intervention with physical therapy and appropriate pain management is crucial for optimal outcomes and to prevent chronic shoulder dysfunction.

Pitfalls to Avoid

• Delaying physical therapy intervention
• Prolonged immobilization which can lead to frozen shoulder
• Overreliance on pain medications without addressing underlying mechanical issues
• Failing to progress from conservative management when appropriate
• Using advanced imaging (MRI, CT) before plain radiographs in initial evaluation 3