Treatment of Shoulder Strain
For acute shoulder strain, initiate immediate RICE protocol (rest, ice, compression) with NSAIDs, followed by early physical therapy focusing on flexibility and strength restoration as pain subsides. 1
Initial Management (First 48-72 Hours)
Immediate interventions:
- Rest the affected shoulder and avoid activities that reproduce pain 1
- Apply ice to reduce inflammation and pain 2, 3
- Compression to minimize swelling 1
- NSAIDs (ibuprofen or acetaminophen) for pain relief and inflammation control 2, 3, 1
Avoid overhead pulley exercises as they encourage uncontrolled abduction and may worsen shoulder strain 2, 3
Early Rehabilitation Phase (Days 3-14)
Range of motion exercises should begin as pain and swelling subside 1:
- Focus on gentle stretching and mobilization techniques, particularly emphasizing external rotation and abduction 2, 3
- Active range of motion should be increased gradually while restoring alignment and strengthening weak muscles in the shoulder girdle 2, 3
- Heat and soft tissue massage can be added as adjunctive modalities 2, 3
Progressive Strengthening Phase (Weeks 2-6)
Physical therapy to restore flexibility and strength is essential once acute pain resolves 1:
- Initiate strengthening exercises for rotator cuff and shoulder girdle muscles 2
- Progress intensity gradually based on pain tolerance 1
Refractory Cases or Severe Strains
If symptoms persist beyond 6-8 weeks of conservative treatment, consider:
- Functional electrical stimulation (FES) may be considered as an adjunctive treatment 2, 3
- Shoulder strapping or supportive devices for additional support if needed 2, 3
- Corticosteroid injections (subacromial or intra-articular) if inflammation persists or pain is related to subacromial pathology 2, 3
Prevention Strategies
Adequate warm-up before intense exercise and avoiding excessive fatigue help prevent muscle strain injury 1:
- Proper conditioning and gradual progression of overhead activities 1
- Maintaining shoulder flexibility and strength 1
Expected Outcome
The long-term outcome after muscle strain injury is usually excellent with few complications when treated appropriately 1. Most patients respond well to conservative management without requiring surgical intervention 4.
Imaging is not immediately necessary unless trauma occurred or symptoms persist beyond 6-8 weeks, with plain radiographs being first-line if needed 5, 3.