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Shoulder Pain Treatment
The shoulder is a marvel of nature. Your shoulder allows you to throw a baseball, scratch your back, and wrap someone in a hug. Likewise, when the shoulder is injured and in pain, it interferes with virtually every daily activity. Keeping the shoulders in proper working order is important, as anyone that has had shoulder pain will tell you. Therefore if a shoulder injury occurs, prompt and effective shoulder pain treatment is of the utmost importance.
Cool it (early, not late)
If you have ever seen a professional pitcher or quarterback after a game, you have seen an ice pack wrapped in bandage around his shoulder. There is an excellent reason for this: ice reduces inflammation. Every biological structure slows down when it is cold and that is no different for the cells and proteins of inflammation. By getting ice on a shoulder early, the inflammatory process is greatly inhibited. The sports trainers know that ice is one of the first interventions in shoulder pain treatment. Even if the athlete does not have pain when they apply the ice, reducing inflammation will help keep the shoulder pain from developing.
Drugs can help...sometimes
There are more powerful ways of reducing inflammation in the shoulder joint-with drugs and injections. NSAIDs (non-steroidal anti-inflammatory drugs) can reduce inflammation and treat shoulder pain, but they come at a cost. NSAIDs tend to wreak havoc on the gastrointestinal system. Taking them can lead to gastrointestinal bleeding, diarrhea, and even kidney problems over time. One or two pills are rarely a problem, but NSAIDs for long term shoulder pain treatment can cause real problems. Likewise an injection of corticosteroids into the shoulder joint is an incredibly powerful tool to reduce inflammation, but it should only be done infrequently. The steroids tend to become less effective over time and can cause the joint to degenerate with repeated administration. While drugs can be used as an adjunct shoulder pain treatment, they are not appropriate as monotherapy (single treatment).
Physical therapy is essential for shoulder pain treatment
Shoulder pain treatment without physical therapy is not shoulder pain treatment at all, really. Physical therapy is divided into three phases: acute, recovery, and rehabilitation (maintenance). In the acute phase of physical therapy shoulder pain treatment, exercises are directed keeping the shoulder structures active without overworking them or continuing to strain them. This period is activity is sometime referred to as relative rest; it is not a complete absence of activity but inciting, injurious activities are aboided. The recovery phase includes more robust activities for the shoulder muscles, joint, tendons, and ligaments. Shoulder pain treatment here consists of exercises to improve range of motion, to increase strength in the various shoulder muscles, and to develop proprioception. Proprioception is the brain's ability to correctly and precisely sense how the joint and muscles are oriented in space. The last phase is rehabilitation or maintenance. This phase builds on the previous shoulder pain treatment and also improves task-specific shoulder performance. The rationale holds that if the shoulder (and the patient) is better at performing the task that injured it, perhaps the task will not cause injury in the future.
To cut or not to cut?
The decision to use orthopedic surgery as a shoulder pain treatment needs to be carefully considered. The consensus in the medical literature is that shoulder surgery should be reserved as a last resort and only for shoulder pain that is not responsive to more conservative treatments. In some cases, (e.g. a rotator cuff tear or an arthritic acromion) surgery can be helpful; however, the risks of surgery must be weighed against the benefits. When considering surgery for shoulder pain treatment, it is important to consult with physical and occupational therapists as well as sports medicine doctors and physicians who specialize in physical medicine and rehabilitation (PM&R). These medical professionals may offer an interesting counterpoint to the orthopedic surgeon perspective (and help you avoid surgery in some cases).
shoulder pain treatment references
Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg. Jul-Aug 2009;18(4):652-60.
Dixit R. Nonoperative management of shoulder injuries in sports. Phys Med Rehab Clin N Am. 1994;5(1):69-80.
Mantone JK, Burkhead WZ Jr, Noonan J Jr. Nonoperative treatment of rotator cuff tears. Orthop Clin North Am. Apr 2000;31(2):295-311.
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