What is the treatment for a 46-year-old patient with shoulder pain lasting 2 months?

From the Guidelines

For a 46-year-old patient with shoulder pain lasting 2 months, I strongly recommend starting with conservative management, including physical therapy and potential corticosteroid injections, as the most effective approach to improve pain and function, as supported by moderate evidence from the 2020 study in The Journal of the American Academy of Orthopaedic Surgeons 1. The treatment plan should include rest from aggravating activities, ice for 15-20 minutes several times daily, and over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily) for 1-2 weeks. Key aspects of the treatment plan include:

• Physical therapy focusing on gentle range of motion exercises and rotator cuff strengthening for 6-8 weeks
• Home exercises such as pendulum stretches, wall crawls, and internal/external rotation with a resistance band
• Potential use of a single injection of corticosteroid with local anesthetic for short-term improvement in both pain and function, as recommended by the 2020 study 1 If pain persists after 2-3 weeks of this regimen, further medical evaluation may be necessary to consider prescription-strength anti-inflammatories, advanced imaging like an MRI to rule out rotator cuff tears, impingement syndrome, or frozen shoulder. Applying moist heat before exercises and ice afterward can help manage inflammation. Given the age of the patient, shoulder pain is commonly caused by rotator cuff tendinopathy, impingement, or early degenerative changes, and most cases improve with appropriate conservative management within 2-3 months, as discussed in the context of traumatic shoulder pain in the 2018 study in the Journal of the American College of Radiology 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain

The treatment for a 46-year-old patient with shoulder pain lasting 2 months may include NSAID medicines, such as naproxen, to help manage pain and inflammation. However, it is essential to consult a healthcare provider to determine the best course of treatment, as the FDA label does not provide specific guidance for this condition 2.

• The patient should take the lowest dose possible for their treatment.
• The patient should take the medication for the shortest time needed.
• The healthcare provider should be informed of all medical conditions and all medicines the patient is taking.

From the Research

Treatment Options for Shoulder Pain

The treatment for a 46-year-old patient with shoulder pain lasting 2 months can be approached in several ways, depending on the underlying cause of the pain.

• A movement system impairment (MSI) diagnosis can be used to guide treatment, as seen in a case report where a patient with shoulder pain was diagnosed with humeral anterior glide with scapular downward rotation 3.
• The treatment focused on correction of shoulder alignment, functional movements, and associated impairments of muscle function, resulting in positive short- and long-term outcomes 3.
• Assessment and management of shoulder pain at the primary care level can also be effective, with correct assessment of the patient's shoulder condition being a prerequisite for appropriate management 4.
• Common causes of shoulder pain can be treated non-surgically with treatments such as physiotherapy, anti-inflammatory medication, and local corticosteroid injections 5.
• In some cases, surgical intervention may be necessary to correct and restore the patient's prior level of shoulder function 5.

Non-Surgical Treatment

Non-surgical treatment options for shoulder pain include:

• Physiotherapy, which can help to improve shoulder function and reduce pain 3, 5.
• Anti-inflammatory medication, which can help to reduce pain and inflammation 5.
• Local corticosteroid injections, which can help to reduce pain and inflammation 5, 6.
• Conservative measures, such as rest and exercise, which can help to improve shoulder function and reduce pain 6.

Surgical Treatment

Surgical treatment options for shoulder pain may be necessary in some cases, such as:

• Rotator cuff tears, which can be treated with surgical repair, superior capsule reconstruction, subacromial decompression, or reverse shoulder arthroplasty 7.
• Other conditions, such as impingement syndrome, adhesive capsulitis, calcified tendonitis, cervical radiculopathy, glenohumeral osteoarthritis, and biceps tendonitis, which may require surgical intervention 5.