What is the recommended treatment for right shoulder pain?

Treatment of Right Shoulder Pain

The recommended treatment for right shoulder pain includes a comprehensive approach of gentle stretching and mobilization techniques, analgesics such as acetaminophen or ibuprofen for pain relief, and consideration of corticosteroid injections for inflammation. 1, 2

Initial Assessment

• Evaluate tone, strength, soft tissue changes, joint alignment, pain levels, and orthopedic changes in the shoulder 1
• Assess for potential causes including adhesive capsulitis, traction/compression neuropathy, complex regional pain syndrome, shoulder trauma, bursitis/tendonitis, rotator cuff tear, or heterotrophic ossification 1
• Determine if pain is traumatic (fractures, dislocations) or non-traumatic (rotator cuff disorders, inflammatory conditions) 3
• Radiographic evaluation should include anteroposterior views in internal and external rotation and an axillary or scapula-Y view to properly assess alignment and potential fractures 3

First-Line Treatment Options

• Range of motion exercises focusing on external rotation and abduction to prevent frozen shoulder and shoulder-hand pain syndrome 1
• Active range of motion should be increased gradually while restoring alignment and strengthening weak muscles in the shoulder girdle 1
• Avoid overhead pulley exercises as they encourage uncontrolled abduction and may increase pain 1
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400mg every 4-6 hours as needed) for pain relief 1, 2, 4
• Modalities including ice, heat, and soft tissue massage 1

Second-Line Interventions

• Intra-articular corticosteroid injections (triamcinolone) for patients with inflammation or when pain is related to injury of the subacromial region 1
• Subacromial corticosteroid injections when pain is thought to be related to rotator cuff or bursa inflammation 1
• Shoulder strapping or slings for support, especially if there is subluxation 1
• Functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES) may be considered for shoulder pain 1

Advanced Interventions

• Botulinum toxin injections into the subscapularis and pectoralis muscles when shoulder pain is related to spasticity 1
• Suprascapular nerve blocks may be considered as an adjunctive treatment for persistent shoulder pain 1
• For severe cases unresponsive to conservative management for 3-6 months, surgical options may be considered 5

Special Considerations

• For Complex Regional Pain Syndrome (CRPS), an early course of oral corticosteroids (30-50 mg daily for 3-5 days, then tapering over 1-2 weeks) can reduce swelling and pain 1
• Positioning and use of supportive devices should be considered for shoulder subluxation 1
• Patient and family education on proper positioning and range of motion exercises is essential, particularly before discharge or transitions in care 1

Treatment Algorithm

1. Start with analgesics (acetaminophen or ibuprofen) and gentle stretching/mobilization techniques 1, 2
2. Add physical modalities (ice, heat, massage) and proper positioning 1
3. If inadequate response after 2-4 weeks, consider corticosteroid injections 1, 6
4. For spasticity-related pain, consider botulinum toxin injections 1
5. For persistent pain, consider suprascapular nerve blocks 1
6. If conservative management fails after 3-6 months, consider surgical referral 5, 6