What is the recommended management for right shoulder pain after an x-ray, currently using Biofreeze, with a follow-up in three months?

Management of Right Shoulder Pain After X-ray with Biofreeze

Conservative management with physical therapy, including therapeutic exercises and mobilization, is strongly recommended for right shoulder pain after normal X-ray findings, with continued use of Biofreeze for symptomatic relief until the follow-up appointment in three months. 1

Initial Assessment and Imaging

• Radiography (X-ray) is the preferred initial diagnostic modality for evaluating shoulder pain, as it can effectively delineate shoulder malalignment and most shoulder fractures 1
• A standard set of shoulder radiographs should include at minimum three views: anteroposterior (AP) views in internal and external rotation and an axillary or scapula-Y view 1
• If X-ray findings are normal or indeterminate but symptoms persist, further imaging may be considered based on clinical presentation 1

Topical Treatment with Biofreeze (Menthol)

• Biofreeze contains menthol which temporarily relieves minor aches and pains of muscles and joints due to simple backache, arthritis, strains, bruises, and sprains 2
• Application instructions: Apply 3-4 drops of medicated oil to the affected area 1-2 times daily; a warm pad may be placed on the affected area for 10 minutes followed by massage 2
• Warnings: For external use only; avoid contact with eyes or mucous membranes; do not bandage tightly; discontinue use if condition worsens, symptoms persist for more than 7 days, or excessive skin irritation develops 2

Physical Therapy Recommendations

• Therapeutic exercises and mobilization are strongly recommended for reducing pain, improving range of motion (ROM), and function in shoulder pain 3, 4
• Active range of motion should be increased gradually in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle 1
• Passive physical therapy should be avoided in the freezing phase if adhesive capsulitis (frozen shoulder) is suspected 5
• Low-level laser therapy may be considered for pain relief and improving function 3

Pain Management

• If there are no contraindications, oral analgesics such as acetaminophen or ibuprofen can be used for pain relief 1
• For persistent pain unresponsive to conservative measures, corticosteroid injections may be considered 3, 6
• Electrotherapy modalities may help provide short-term pain relief 3

Follow-up Recommendations

• The three-month follow-up is appropriate for evaluating progress with conservative management 1
• If symptoms persist or worsen despite conservative management, additional imaging such as MRI may be considered at follow-up to evaluate for soft tissue injuries 1
• Most soft-tissue injuries (such as labral tears and rotator cuff tears) can undergo a period of conservative management before considering surgical options 1

Special Considerations

• If symptoms worsen significantly before the scheduled follow-up, earlier reassessment is warranted 2
• Only about 10% of patients with shoulder pain require surgical intervention 5
• Patients with comorbidities such as diabetes and thyroid dysfunction tend to have poorer outcomes and may require more aggressive management 5