Non-surgical management of shoulder pain

Shoulder pain presentations are a common complaint in a clinical setting and some research suggests of the individuals that have new episodes of shoulder pain and that do not seek treatment:
  • 70% will still have pain after 6 weeks.
  • 50% will still have pain after 6 months.
  • 40% will still have pain after one year.
At OnePontHealth we pride ourselves on an accurate diagnosis and correlating these with specific impairments to ensure you get a targeted treatment approach:
  1. Exclude involvement of the cervical spine (neck).
  2. Is the shoulder stiff and painful? Test external rotation, must have 50% range of motion.
  3. Is the shoulder weak and painful? Look at pain with resisted tests.
  4. Is the shoulder unstable and painful? There may be increased range of motion and apprehension to perform certain movements.
  5. Can we get the patient to reproduce the pain with a movement? We then use this as our baseline test.
A stiff and painful shoulder
This leads a clinician to the two most common complaints that lead to shoulder stiffness and these are osteoarthritis and frozen shoulder. If there is a high velocity mechanism, such as fall, then fracture or dislocation will need to be ruled out.
A weak and painful shoulder
Rotator cuff injury is the leading cause of a weak and painful shoulder. These injuries encompass rotator cuff tendinopathy, degeneration, partial thickness tears and full thickness tears. Increased pain and giving way can be experienced when the arm is moved overhead in front and to the side of the body.
An unstable and painful shoulder
Shoulder pain with feelings of an unstable joint will usually mean you have a condition called glenohumeral instability. Symptoms may range from pain at the front and side of the shoulder girdle, vague uncomfortable sensations, apprehension, increased range of motion, and multiple shoulder dislocations.
Take home message
Therapeutic exercise is often the most supported approach for painful shoulder conditions, particularly rotator cuff injuries and shoulder instability. A good clinician should find the impairments of your shoulder pain, and then direct specific interventions towards them. Impairments might include weakness, loss of range of motion, pain, muscle endurance and coordination of movement.