Shoulder Pain

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Pain Management Information for Patients
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Treatment

Shoulder pain treatment depends on the cause. Pain that occurs as a result of overuse, sprain, or strain often is treated using conservative measures. Rest, immobilization, ice or heat, and compression can be used to treat some types of shoulder pain.

It is important to rest the shoulder and avoid activities that increase pain or put pressure on the joint for at least 48 hours. Conservative treatment also may involve applying ice or heat to the affected area several times a day to help reduce pain and inflammation. Compression involves using elastic bandages to help stabilize the shoulder and reduce swelling.

Medications such as over-the-counter analgesics (e.g., acetaminophen) can be used to relieve pain and nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen, aspirin) can be used to reduce pain and inflammation. These medications should only be taken as directed and should not be used for longer than 7 to 10 days without consulting a physician. They may cause side effects, such as stomach pain, gastrointestinal bleeding, and rarely, liver and kidney problems. In some cases, NSAIDs can cause severe gastrointestinal and cardiovascular side effects.

Severe pain or pain that does not respond to over-the-counter pain relievers may require prescription medication (e.g., COX-2 inhibitors [Celebrex®]). These medications may cause gastrointestinal bleeding and adverse cardiovascular events.

Antibiotics are used to treat shoulder pain that is caused by an infection (e.g., septic bursitis). If oral antibiotics are not effective, they may be administered through an IV (intravenously).

Cortisone injections may be used to treat some types of shoulder pain (e.g., bursitis, tendonitis) that does not respond to conservative treatment. This therapy involves injecting cortisone (a steroid and anti-inflammatory) directly into the shoulder. Over time, cortisone injections can weaken or damage tissues and structures within the joint.

Physical therapy (e.g., ultrasound, electric stimulation, cryotherapy, manual therapy, stretching) may be used to reduce pain and inflammation and to strengthen the muscles and reduce friction within the shoulder joint. It also can be helpful to teach the patient proper body mechanics, which may reduce the risk for recurrence.

Some types of shoulder pain (e.g., separation, dislocation, fracture) require immobilization of the joint. Separated shoulders are often treated using a sling to immobilize the shoulder. In most cases, this type of injury heals in 2 or 3 months. When the shoulder joint is dislocated, the physician puts the ball of the humerus bone back into the socket (called reduction) and the shoulder is stabilized using a sling or special device (called an immobilzer) for several weeks.

Surgery may be necessary to treat serious shoulder injuries or conditions (e.g., bone misalignment, damaged tendons, severe tears). Shoulder surgery may be traditional open surgery (requiring a larger incision) or arthroscopic surgery (performed through tiny incisions).

Shoulder surgery usually is followed by a period of immobilization and extensive physical therapy to regain motion and strength. Following shoulder surgery, patients often have some tenderness in the area for several months.

Arthritis that causes severe wear and tear of the shoulder joint may require shoulder joint replacement (arthroplasty). In this procedure, the ball of the humerus and socket of the shoulder blade (scapula) are replaced with an artificial ball and cap. Almost immediately following shoulder joint replacement, passive shoulder exercises are started. In passive exercises, a qualified health care provider moves (manipulates) the joint. About 3 to 6 weeks after surgery, patients can begin shoulder stretching and strengthening exercises.

Prevention

Shoulder pain cannot be prevented in every case. To help prevent the condition, avoid overusing the shoulders and use care when participating in activities that put pressure on the shoulder joints (e.g., repetitive overhead motions). Proper body mechanics and posture, and warming up and stretching correctly before exercising also can help. Ask a qualified health care provider how to begin an exercise program to help strengthen shoulder muscles.

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