What is the treatment for acute right shoulder pain without a known injury?

Treatment for Acute Right Shoulder Pain Without Known Injury

For acute right shoulder pain without a known injury, initial management should include radiographic evaluation with standard shoulder X-rays (anteroposterior views in internal and external rotation, and axillary or scapula-Y view), followed by conservative treatment including rest, pain management, and appropriate physical therapy. 1

Diagnostic Approach

• Radiographs are the preferred initial imaging modality for evaluating acute shoulder pain as they can effectively demonstrate fractures, dislocations, and shoulder malalignment 1, 2
• A complete radiographic shoulder examination should include at minimum three views: anteroposterior (AP) views in internal and external rotation, and axillary lateral view or scapula-Y view 1, 2
• If radiographs are normal or indeterminate but symptoms persist, MRI without contrast may be appropriate to evaluate for soft tissue injuries such as rotator cuff tears 1
• Ultrasound has limited usefulness in acute shoulder pain unless symptoms can be localized to the rotator cuff or biceps tendon 1

Conservative Management (First-Line Treatment)

• For shoulder pain of any duration, consider multimodal care including heat/cold application, joint mobilization, and range of motion exercises 3
• Pain management options include:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief 4
  • Acetaminophen (paracetamol) as an alternative for those who cannot take NSAIDs 4
• For persistent pain, consider low-level laser therapy which has shown effectiveness for shoulder pain of any duration 3
• Cervicothoracic spine manipulation and mobilization may be beneficial when shoulder pain is associated with neck pain or restricted cervicothoracic spine movement 3

Exercise-Based Interventions

• For shoulder pain lasting more than 3 months, stretching and strengthening exercises should be implemented 3
• Avoid overhead pulley exercises which encourage uncontrolled abduction 2
• Range of motion exercises focusing on external rotation and abduction are recommended 2

Treatments to Avoid

• Ultrasound therapy has not shown significant benefit for shoulder pain 3
• Taping, interferential current therapy, and soft tissue massage alone are not recommended 3
• Shock-wave therapy is not recommended for general shoulder pain (though it may be considered specifically for calcific tendinitis) 3

When to Consider Advanced Treatment

• If conservative management fails after a 3-6 month period, surgical options may be considered 5
• Referral to a specialist should be considered in cases of:
  • Presence of neurological deficits 2
  • Suspected massive rotator cuff tears that may require expedited repair 1
  • Persistent pain despite appropriate conservative management 5

Monitoring and Follow-up

• Reassess the patient's status at each visit for:
  • Worsening of symptoms
  • New physical, mental, or psychological symptoms
  • Response to treatment 3
• Most non-traumatic shoulder pain is self-limited and benign in nature, and patients should be reassured about this 6

Remember that the majority of acute shoulder pain cases without known trauma can be effectively managed with conservative treatment, and only a small proportion of patients will ultimately require surgical intervention 5.