What is the best course of treatment for a 27-year-old male patient with dull and constant right shoulder pain, likely due to heavy workouts with 35 pounds dumbbells?

Management of Exercise-Induced Shoulder Pain in a Young Weightlifter

For this 27-year-old male with dull, constant right shoulder pain from heavy dumbbell workouts, immediately reduce training weight by 40-50% and implement relative rest with modified activity while initiating conservative management with NSAIDs and progressive eccentric strengthening exercises. 1

Immediate Activity Modification

• Reduce dumbbell weight from 35 pounds to approximately 15-20 pounds (40-60% of current weight) to prevent further tendon damage and allow healing. 1
• Implement relative rest by decreasing repetitive loading of the affected shoulder rather than complete cessation of activity, as this prevents further damage while promoting healing and pain relief. 1
• Avoid overhead exercises and aggressive range-of-motion activities that could exacerbate tendon injury. 1

Pain Management

• Start naproxen 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours for acute pain relief (maximum 1250 mg first day, then 1000 mg daily thereafter). 2
• NSAIDs provide short-term pain relief but do not alter long-term outcomes, so they should be used as an adjunct to other therapies rather than primary treatment. 1
• Apply cryotherapy with melting ice water through a wet towel for 10-minute periods repeatedly, as this provides acute relief of tendinopathy pain. 1

Rehabilitation Protocol

• Begin eccentric strengthening exercises once acute pain subsides, as this is the most effective treatment for tendinopathy and may reverse degenerative changes. 1
• Start with lower resistance (40-60% of maximum capacity) and higher repetitions (15-20 repetitions), focusing on proper form and breathing to prevent Valsalva maneuver. 1
• Gradually increase active range of motion in conjunction with restoring shoulder alignment and strengthening weak muscles in the shoulder girdle, particularly focusing on rotator cuff and periscapular muscles. 1, 3

Progressive Return to Training

• Begin with brief exercise sessions (10 minutes), adding 5 minutes per session until 30 minutes is reached before increasing intensity. 1
• Use pain threshold as an intensity guide, starting with as few as 2-3 repetitions and working up to 10-12 repetitions, 2-3 days per week. 1
• Focus on cross-training and functional exercises rather than isolated heavy lifting during the recovery phase. 1

Red Flags Requiring Further Evaluation

• If pain persists beyond 3-6 months of conservative therapy, consider imaging with radiographs (anteroposterior views in internal/external rotation plus axillary view) to assess for structural pathology. 1, 3
• Discontinue exercise if unusual or persistent fatigue, increased weakness, decreased range of motion, or joint swelling/pain lasting more than one hour after exercise occurs. 1
• Consider corticosteroid injection into subacromial space if pain is thought related to rotator cuff or bursa inflammation after 4-6 weeks of failed conservative management. 1, 3

Common Pitfalls to Avoid

• Do not continue training at current weight loads, as this perpetuates the overuse injury cycle and risks progression from acute tendinitis to chronic tendinosus with degenerative changes. 1
• Avoid aggressive passive range-of-motion exercises, as improper technique with the complex shoulder joint could cause more harm than good. 1
• Do not rely solely on NSAIDs without implementing activity modification and strengthening exercises, as medications alone do not alter long-term outcomes. 1
• Resistance training itself prevents injuries when performed correctly with appropriate loads, but excessive weight creates the injury risk seen in this patient. 4