Shoulder pain is the third most common self-reported injury in our society. Shoulder sprains are related to tissues and ligaments. Strains are associated with muscles. There are a variety of conditions related to shoulder pain such as Bursitis, Rotator Cuff Injury, Osteoarthritis, and Frozen Shoulder Syndrome. If shoulder pain persists for more than 2-3 weeks, a healthcare professional should be contacted.
Evaluated on the RESCU Rating Scale
R = Risk E = Effectiveness S = Self-Care
C = Cost U = Usefulness (overall rating)
1 = Least Favorable 5 = Most Favorable
| R | E | S | C | U(overall rating) | |
| Chiropractic | 5 | 3 | 0 | 5 | 3 |
| Laser | 5 | 3 | 0 | 4 | 3 |
| Hot & Cold Packs | 5 | 2 | 5 | 5 | 5 |
| Medication NSAIDS | 2 | 3 | 5 | 4 | 3 |
| Electrical Stimulation | 5 | 2 | 4 | 5 | 3 |
| Acupuncture | 5 | 1 | 0 | 4 | 2 |
| Injections | 1 | 2 | 0 | 1 | 1 |
| Surgery | 3 | 3 | 0 | 1 | 4 |
Shoulder pain is extremely common in our society. In fact, it is the third most common self-reported injury according to recent literature. [i] There are several common causes of shoulder pain which include (but are not limited to):
There are a variety of treatments available in health care to address these common conditions. Proper diagnosis is critical to determine the best course of treatment so be sure to consult your doctor if shoulder pain persists. While mild to moderate shoulder pain may be self-limiting and resolve with time, whether it is treated or not, ongoing shoulder pain (beyond 4 weeks) should be evaluated with proper diagnostic tests (ex. X-ray, MRI). It is a generally accepted principle in health care that in order to prevent the development of chronic pain, one must adequately address the pain when in the acute state. Therefore, do not hesitate to contact a healthcare provider if pain persists beyond a few weeks.
Sources:
[i] Schuh-Renner et al. Accuracy of self-reported injuries compared to medical record data.
Musculoskelet Sci Pract. 2019 Feb;39:39-44. doi: 10.1016/j.msksp.2018.11.007. Epub 2018 Nov 19.
These two terms are often used as one even though the tissues affected are vastly different.
Sprain: In general, a “sprain” is related to the connective tissue around the joints and involves stretching or tearing of the tissue/ligament, secondary to some sort of trauma or overuse. Ligaments connect bones together while tendons connect the muscle to bone. Both ligaments and tendons are associated with poor blood supply, thus the healing time associated with injury to these tissues is rather slow and often incomplete, often leading to chronic pain and arthritis later in life. It is generally accepted that sprains range in severity from Grade 1 (a few fibers are torn) to Grade 3 (completely torn tissue).
Strain: In general, a “strain” is related to the muscles, which are very vascular (good blood supply), thus healing normally takes place in a shorter period, and healing is typically more complete.
There are a variety of treatments which can be used to treat sprain/strain of the shoulder with include but is not limited to the following:
The summary chart above is provided to find the treatment options you may want to consider in order of their overall effectiveness.
Bursitis is a condition caused by inflammation of the bursa. The “bursa” is a sac located between tissues in the shoulder which reduces friction when moving the shoulder. The most common bursa in the shoulder to become inflamed is the subacromial bursa leading to “Subacromial bursitis”. The subacromial bursa separates numerous shoulder ligaments from deep tissue muscles. The subacromial bursa helps the motion of the shoulder so you can engage in common activities related to overhead work (ex. painting, cleaning windows, etc.)
Regardless of the cause, there are a variety of treatments to address the correction of and pain associated with bursitis. Many non-operative treatments include, but are not limited to:
Normally bursitis responds favorably to conservative care but may require a variety of treatment options mentioned above. Please refer to the summary chart [hot link to Treatment Options chart above] at the beginning of this section to help you find the treatments you may want to consider in order of their overall rating.
The “rotator cuff” is NOT a specific muscle or tissue. A rotator cuff (RTC) tear is an injury to one or more of the tendons or muscles of the rotator cuff of the shoulder, which may include: Suprasupinatus, infrasupnatus, teres minor, subscapularis. Symptoms of a RTC tear may include: shoulder pain, reduced and painful movement, or weakness. [i]
RTC tears may occur as the result of an acute injury, or may be chronic, developing over a period of time secondary to age, overuse and common activities of daily living/work, or as a result of participating in sporting activities.
Similar to bursitis, treatment may include but is not limited to the following:
Please refer to the summary chart [hot link to Treatment Options Chart above] at the beginning of this section to help you find the treatments you may want to consider in order of their overall rating.
Osteoarthritis (OA) is a type of joint disease that occurs when joint cartilage breaks down gradually over time. Symptoms may include joint pain and stiffness, a grinding sensation, and eventually reduced or limitation of motion. In early stages, there may be no pain at all. A simple plain film X-ray is normally all that is required to identify the presence and severity of osteoarthritis of the shoulder.
OA can develop over time secondary to overuse activity (ex. physical stress of a job, sports, etc.) causing mechanical irritation of the joint. It can also be associated with genetics or associated with past trauma. Osteoarthritis, the most common form of arthritis, affects about 237 million (3.3% of the population) people globally.
Frozen shoulder syndrome (FS) is a frustrating condition to experience or treat. FS is often referred to as adhesive capsulitis and is commonly associated with extreme stiffness and pain in the shoulder joint due to the connective tissue surrounding the shoulder joint becoming inflamed and stiff, greatly restricting motion. FS syndrome can lead to significant chronic shoulder pain. Pain is usually constant. It is often worse at night leading to sleep deprivation, and also worse with cold weather. Movement of any kind can cause additional pain and cramping.
The condition often develops after suffering injury or trauma or non-related conditions which result in lack of shoulder movement as they recover. Examples include recovery from stroke or heart attack. The longer one goes without movement, the greater the chances of developing FS. This condition can also lead to depression, pain in the neck and back, lack of concentration and weight loss secondary to loss of sleep, and inability to engage in common activities of daily living due to pain. With time and proper treatment, most people regain about 90% of shoulder motion.
The normal course of a frozen shoulder has been described as having three stages:
Stage one: The “freezing” or painful stage. This stage could extend over six weeks to nine months and be associated with a slow onset of pain. As the patient experiences worsening pain, the shoulder loses motion.
Stage two: During the “frozen” or adhesive stage, the patient may experience a slow reduction in pain, but the stiffness remains. This stage could last from four to nine months.
Stage three: During the “thawing” or recovery stage, the patient may experience an improvement in shoulder motion. While some patients may respond without treatment over time, many require significant intervention to recover from this troubling condition. Recovery could take from 6 months to 2 years.
According to recent literature, manual therapy and a specific exercise program can produce clinically meaningful changes related to shoulder range of motion, pain, disability and muscle strength. [ii]
Treatment: Typical management of FS syndrome/adhesive capsulitis includes non-surgical options including, but not limited to, the following:
In the worst cases, surgery may be required if the patient is not responding to conservative care options. Please refer to the summary chart [hot link to Treatment Options Chart above] at the beginning of this section to help you find the treatments you may want to consider in order of their overall rating.
Sources:
[i] Eisenberg. “Treatment Options for Rotator Cuff Tears: A Guide for Adults”. Center for Clinical Decisions and Communications, Science (2005).
[ii] Dueñas et al. A 12-Week Tailored Manual Therapy and Home Stretching Program Based on Level of Irritability and Range of Motion Impairments in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series With 9-Months Follow-Up.
J Orthop Sports Phys Ther. 2019 Jan 18:1-24. doi: 10.2519/jospt.2019.8194. [Epub ahead of print]
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