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Shoulder

Non-Surgical Shoulder Pain Treatment

What is shoulder pain?

Shoulder pain can become a serious condition ranging from mild discomfort with overhead activities or reaching back, to severe weakness and the incapacity to comb your hair, eat comfortably or touch your back. As such, everything from daily activities to sporting activities can be significantly impaired. If you begin to notice that the pain lingers for more than a couple of weeks or is more severe than what you typically experience, then it’s important to consult a physician for further evaluation. When it comes to the shoulder, a timely diagnosis and treatment can prevent further injury down the line.

Initial Evaluation of shoulder pain with my practice

At your initial evaluation with our team, x-rays will typically be obtained in order to further evaluate the bone structure, and the anatomy. Following the x-rays, a physical exam will help to determine where the source of the pain may be. In some cases, further diagnostic imaging, such as an MRI or CT scan, may be required to confirm the diagnosis and help establish potential treatment options for you.

Where is your pain?

Your treatment will be tailored according to where the symptoms are coming from. Depending on where you feel the pain and other clues from your history and physical exam, we can determine where your pain is coming from. Important clues to consider are:

  • Is the pain coming from the front or side of the shoulder?
  • Are you able to sleep on the shoulder, or does the pain wake you up in the middle of the night?
  • Are your symptoms present when you do overhead activities or when trying to reach back.

Additionally, there are certain features that can make us suspect different diagnoses. For example, weakness with motion or instability can point to a rotator cuff tear or a labral tear respectively. Pain in the front of the shoulder may indicate a biceps pathology. The biceps tendon is the most common source of shoulder pain and can sometimes get irritated and inflamed. Another common condition is a frozen shoulder, or adhesive capsulitis. Patients with frozen shoulder can sometimes experience significant shoulder stiffness and pain.

How to manage your shoulder pain

Non-surgical approaches can improve the vast majority of shoulder conditions. When there is a rotator cuff injury or labral tear, conservative treatment can improve your strength, the mobility of your joint by stabilizing the scapula (an important bone from the shoulder), and allow for overall better joint function. With the appropriate muscular training and activity modification, symptoms can often be relieved completely, allowing many patients to return to their desired level of activity without ever having required surgery.

Read below for some of the options that we encourage our patients to try after their initial visit with our team.

Anti-inflammatory Drugs

Anti-inflammatory medications can be utilized as a first line of treatment, primarily when treating mild to moderate pain associated with inflammation. Joints and tendons sometimes get inflamed after experiencing an injury, accident, or repetitive use of the joint. In some cases, inflammation can occur with no eliciting reason at all. In these cases, anti-inflammatories can significantly help to reduce the inflammation, resulting in a decrease in your pain. It is important to know the dosage in order to avoid side effects from these medications. Additionally, they should not be taken for an extended period of time, as they can lead to further systemic problems.

Physical therapy

Physical therapy is a key component in treating shoulder pain.  Physical therapy can target several areas that can help mitigate and often times solve shoulder pain. Under the guidance of a skilled physical therapist who specializes in shoulder pathology, physical therapy can help strengthen muscles around the shoulder joint, increase flexibility and maintain range of motion of the joint, decrease the inflammation of the joint or tendons surrounding the shoulder, and correct shoulder joint or upper back positions that might be adding to your overall pain.

Injections

Injections are another reasonable conservative treatment option to consider when struggling with shoulder pain, as they can:

  • Help diagnose where exactly the pain is coming from. This type of injection is called a diagnostic shoulder injection.
  • Help treat the pain by decreasing inflammation within the joint or tendons surrounding the shoulder joint.

Diagnostic Shoulder Injections

For this purpose, a numbing drug (lidocaine) is injected directly into the joint. If you experience relief from pain, or at least a reduction in more than 50% of the pain, immediately following the injection, then we can confirm that the shoulder joint is the actual source of pain. For example, if pain is coming from inside the joint (cartilage, labrum) an injection within the joint will help with the pain. However, if there is inflammation in the subacromial space (above the rotator cuff) pain might not improve.

Pain Relief

  • Intra-articular Injections can be an important tool on the treatment of shoulder pain. Cortisone, hyaluronic acid, or platelet rich plasma (PRP) injections made directly into the shoulder joint that can provide symptomatic relief. Regardless of where we inject in the shoulder, the medication will spread out throughout the shoulder, maximizing therapeutic outcomes. Following the injection, pain relief varies from patient to patient. Some may feel symptomatic relief within two to five days. However, if a patient feels no relief within ten days following the injection, the patient is unlikely to gain any additional improvement and further diagnostic testing may be needed to identify other options for relief.
  • Biceps Injections are often prescribed when the diagnosis is thought to be symptomatic biceps tendon inflammation. For this, an ultrasound is used to help guide the provider in administering the injection directly into the biceps sheath.
  • Acromioclavicular (AC) Injections are often prescribed when arthritis and inflammation are present in the AC joint. For this, an ultrasound is used to help guide the provider in administering the injection directly into the AC joint.

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