Treatments for shoulder pain
Treating shoulder pain is complex and dependent upon your diagnosis. We've outlined potential treatments below.
There are a wide range of treatment options available to help with shoulder pain, from self-management tips through to surgical options. To book a consultation with a specialist at Circle, simply complete the form on this page and one of the team will get in touch.
What is the role of exercises and physiotherapy in treating shoulder pain?
Physiotherapy exercises are often the first line of treatment for many shoulder conditions. Even when surgery has been undertaken for shoulder pain, physiotherapy still has a huge role in rehabilitating the shoulder and helping restore full function following the operation.
For acute shoulder pain such as following fractures, dislocations or surgery, initial exercises will focus on maintaining as much shoulder motion as possible and preventing stiffness from developing. A common way to achieve this goal includes pendular exercises which involve using the body motion to swing a relaxed arm front to back or from side to side.
Surgery, severe subacromial pain, fractures, dislocations and frozen shoulders all cause significant shoulder joint stiffness. Physiotherapy exercises, as well as manual mobilisation techniques, may all be used to restore normal shoulder joint flexibility. Furthermore, stretches to thoracic cage, pectoral and latissimus muscles may improve scapular and shoulder posture, thereby reducing the chance of shoulder impingement.
Unless the shoulder is in acute pain, strengthening to the scapular muscles (sometimes referred to in healthcare as scapular retraining) will be addressed with specific movement control and strength exercises. Once improvements are seen, higher level scapular retraining exercises can be prescribed which may include weight bearing exercises such as push ups or reaching exercises against resistance tubing or cables. Whether the primary shoulder problem is related to the rotator cuff muscles or tendons or not, a graded strengthening program to these muscles will improve shoulder stability and function and will also be prescribed as part of a rehabilitation program.
Can shoulder slings and shoulder braces help relieve shoulder pain?
Unless instructed by a qualified healthcare professional, shoulder slings should be avoided if possible as the most common complication of shoulder injury and pain is persistent shoulder stiffness. Wearing a sling may unnecessarily exacerbate this problem.
In cases of very acute shoulder pain immediately after an injury, emergency departments may advise the use of a sling for one to two weeks to manage the pain. Shoulder slings are also advised initially after a shoulder dislocation to minimise the chances of redislocation.
Shoulder braces are sometimes advised to provide some additional support to an unstable AC joint or unstable glenohumeral joint. These specific circumstances normally involve contact sports involving tackling or throwing sports such as baseball and rugby.
Shoulder AC joint braces are normally worn over both shoulders and provide compression across the chest. Glenohumeral support braces are also normally worn over both shoulders and are reinforced with heavy strapping over the front of the shoulder socket and upper arm. This limits the ability of the shoulder to be placed in to extremes of external rotation with the arm elevated, which is the most unstable position for shoulders.
Aside from these reasons, shoulder orthopaedic surgeons will often advise the use of a shoulder sling for comfort immediately after surgery. If stabilisation procedures or rotator cuff repairs have been undertaken, then depending on the exact nature of the procedures, specialist shoulder braces limited to certain movements may be advised.
What is the role of injections in managing shoulder pain?
Injection therapy has two main functions when managing shoulder pain. The first is to produce an anti-inflammatory effect by injecting a medicine into the targeted area. Your consultant will always discuss the full risks versus the potential benefits, but in general these injections are sometimes used to treat subacromial pain that has not responded to physiotherapy or an acutely painful frozen shoulder.
What types of surgery exist for treating shoulder pain?
Although physiotherapy is often the first line of treatment for shoulder pain, surgery for the shoulder has seen huge advances in recent decades. For most individuals suffering with shoulder pain and disability a surgical technique now exists to treat the specific shoulder condition.
For degenerative osteoarthritis to the shoulder joint (glenohumeral joint) shoulder replacements can be considered which can give excellent pain relief and now allow the maintenance of far greater strength and mobility in the shoulder to retain function.
Surgery for subacromial impingement involves a possible combination of several procedures. The first is removing calcium deposits which can build in the subacromial space and rotator cuff tendons. The second may involve a resection of the subacromial bursa and the third possible procedure involves removing bony spurs known as osteophytes from the underside of the AC joint which may be narrowing the space. In some cases, part of the AC joint is resected altogether.
Surgical rotator cuff repairs may be considered as the first line of treatment following a trauma in a young or athletic individual. For massive rotator cuff tears in older individuals, surgery may be considered when there is significant disability. The aim of a rotator cuff repair is to allow the rotator cuff tendons to produce sufficient force across the shoulder joint to enable active movement and eventually sports specific power movements if needed.
The final major area of surgical practice is based around releasing the range of movement in stiff shoulders. The type of operation is often referred to as a capsular release operation and is most commonly performed on frozen shoulders which have not improved as they normally do, or after trauma and/or previous shoulder operations which can lead to significant shoulder stiffness. This operation involves cutting the scarred up and inflexible soft tissue that has developed in the shoulder capsule and then performing a manipulation of the shoulder joint while the patient is under anaesthesia.Shoulder conditions