Treating Shoulder Pain Part 1

There are several types of treatment for shoulder pain. The main treatment options include:

• Avoiding activities that make your symptoms worse
• Painkillers
• Anti-inflammatories
• Physiotherapy – where physical methods, such as massage and manipulation, are used to promote healing
• Surgery (in some cases)

The treatment that you have may depend on the cause of your shoulder pain (see Shoulder pain - causes) and your symptoms. For example, as well as pain, you may also have reduced strength or movement in your shoulder. In this case, a combination of different treatments may be used.


Avoiding Activities

Depending on what is causing your shoulder pain, your GP may recommend that you avoid certain activities or movements that may make your symptoms worse.
For example, in the early, painful stage of frozen shoulder, your GP may suggest that you avoid activities that involve lifting your arms above your head. However, you should continue using your shoulder for other activities because keeping it still could make your symptoms worse.
If you have shoulder instability, your GP may recommend that you avoid any movements that are likely to make the instability worse, such as overarm throwing.
If you have sprained your acromioclavicular joint (the joint at the top of your shoulder), your GP may suggest that you avoid moving your arm across your body. You may also be given a sling (a supportive bandage) to wear to support your arm for up to a week after your injury.

Painkillers

If your pain is mild, taking painkillers such as paracetamol or codeine may be enough to control it. Always follow the dosage instructions on the packet to ensure that the medicine is suitable and that you do not take too much.
If your shoulder pain is more severe, your GP may recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, diclofenac or naproxen.


As well as easing the pain, NSAIDs can also help to reduce swelling in your shoulder capsule. They are most effective when taken regularly rather than when your symptoms are most painful.
Cautions

Side effects can sometimes occur when using NSAIDs. They may include:

• Nausea (feeling sick)
• Diarrhoea
• Headaches
• Dizziness

Before taking NSAIDs, you should speak to your GP if you have any of the following:

• asthma – a long-term condition that can cause coughing, wheezing and breathlessness
• high blood pressure (hypertension)
• kidney problems 
• heart problems

Oral Corticosteroids

Corticosteroids are medicines that contain steroids, which are a type of hormone. Hormones are powerful chemicals that have a wide range of effects on the body, including reducing swelling and pain.
You may be prescribed corticosteroid tablets for frozen shoulder. Some evidence suggests that these may provide short-term pain relief for a few weeks. However, it is not clear whether corticosteroid tablets are any better than the other treatment options, such as corticosteroid injections.

Read Part 2 Here

Treating Shoulder Pain Part 2

 Treating Shoulder Pain:Part 2

Corticosteroid Injections

If your shoulder pain is very severe, such as in certain cases of frozen shoulder, painkillers may not be enough to control the pain. In this case, you may have corticosteroids injected into and around your shoulder joint.
Corticosteroid injections can help to relieve the pain that is caused by frozen shoulder and increase your range of movement for several weeks at a time, particularly during the first stage of symptoms. However, the injections cannot cure your condition completely, and your symptoms will gradually return.
Research also suggests that corticosteroid injections can provide pain relief for up to eight weeks for tendonitis (inflammation of a tendon). They may also improve your ability to use your shoulder, although they may not be as effective as some other treatments, such as NSAIDs.
One study found that corticosteroid injections may be most effective if they are used within 12 weeks of tendonitis symptoms starting. However, some experts believe that the use of corticosteroid injections should be delayed for as long as possible.

Cautions

After having a corticosteroid injection, you may experience a number of side effects at the site of the injection.
Possible side effects can include:

• Temporary pain
• Depigmentation – when your skin becomes lighter 
• Skin atrophy – when your skin becomes thinner as some of the skin cells waste away

Having too many corticosteroid injections can damage your shoulder. Therefore, you may only be able to have this treatment up to three times in the same shoulder in one year.


Hyaluronate Injections

Hyaluronate is another medicine that can be injected into your shoulder to treat shoulder pain. One review of a number of studies found that hyaluronate was effective at reducing pain.
However, the National Institute for Health and Clinical Excellence (NICE) does not recommend hyaluronate to treat osteoarthritis (a condition that affects the joints). It found that hyaluronate only had small benefit and that corticosteroid injections were a better treatment choice. Therefore, hyaluronate may not be used.

Physiotherapy

Physiotherapy, often referred to as physio, uses a number of different physical methods to promote healing. If you are referred to a physiotherapist, they should explain to you what treatment they will use and how it will work. Possible treatments include:

• Massage – where the physiotherapist uses their hands to manipulate your shoulder
• Laser therapy – where the energy from lasers (narrow beams of light) are used to stimulate your nervous system and reduce pain  
• Transcutaneous electrical nerve stimulation (TENS)

TENS is a type of physiotherapy where small electrical pads (electrodes) are applied to the skin over your shoulder. The TENS machines delivers small pulses of electricity through the electrodes, which numb the nerve endings and control your pain.
As well as these treatment methods, your physiotherapist may also recommend shoulder exercises. These will be specific for your needs. For example, if you have shoulder instability, you may be given exercises that will strengthen your shoulder.

Shoulder Exercises

If you have shoulder pain, it is important to keep your shoulder joint mobile by doing gentle, regular exercise. Not using your shoulder can cause your muscles to waste away and may make any stiffness worse. Therefore, if possible, you should continue using your shoulder as normal.
If your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you some exercises that you can do without further damaging your shoulder.
You may be given exercises to carry out on your own or you may complete the exercises with supervision from your GP or physiotherapist. You may also have manual therapy, which is when the healthcare professional moves your arm for you. Manual therapy uses special techniques to move the joints and soft tissues in your shoulder.
One review of a number of studies found that long-term physiotherapy was equally as effective as surgery for impingement syndrome (any type of damage to the tendons in the rotator cuff).

Surgery For Frozen Shoulder

If other treatments for frozen shoulder have not worked, you may be referred for surgery. There are two possible surgical procedures, which are explained in more detail below.

Manipulation

Manipulation involves having your shoulder moved while you are under general anaesthetic. General anaesthetic is a painkilling medication that makes you unconscious. During the procedure, your shoulder will be gently moved and stretched while you are asleep.
Afterwards, you will usually need to have physiotherapy to help maintain mobility in your shoulder. Manipulation may be used if you are finding the pain and disability from your shoulder difficult to cope with.

Arthroscopic Capsular Release

An alternative procedure to manipulation is arthroscopic capsular release. This is a type of keyhole, or non-invasive, surgery. The surgeon will carry out the procedure after making an incision (cut) that is less than 1cm (0.4in) long.
During arthroscopic capsular release surgery, your surgeon will use a special probe to open up your contracted shoulder capsule. They will then remove any bands of scar tissue that have formed in your shoulder capsule, which should greatly improve your symptoms.
As with manipulation, you will need to have physiotherapy after arthroscopic capsular release surgery. This will help you regain a full range of movement in your shoulder joint.

Surgery For A Rotator Cuff Tear

Surgery may be used to treat rotator cuff tears if the tear is very large or if other treatment options have not worked after three to six months. It is possible that having surgery earlier will lead to a quicker recovery, although at the moment there is not enough research into whether early surgery is beneficial or not.
During the procedure, a small amount of bone may be shaved off the bones in your shoulder. Damaged tendons and bursae (fluid-filled sacs that are found over joints and between tendons and bones) may also be removed. This creates more space within the joint to allow your rotator cuff to move freely.

The Operation Can Be Performed As:

• Open surgery – a large incision is made in your shoulder
• Mini-open surgery – a small incision is made in your shoulder 
• Arthroscopic surgery – a type of keyhole surgery that uses a camera to look inside your shoulder joint

Evidence suggests that people return to work about a month earlier if they have mini-open surgery rather than open surgery.
As with frozen shoulder surgery, you will need to have physiotherapy after your operation to help you regain a full range of movement in your shoulder joint.

Surgery For Shoulder Instability

If your shoulder dislocates (the ball comes out of the socket) regularly or severely, you may need to have surgery to prevent it happening again and to prevent the surrounding tissues and nerves from becoming damaged. Depending on the type of instability that you have, surgery may involve:

• Tightening stretched ligaments or reattaching them if they have torn – ligaments are tough bands of connective tissue that link two bones together at a joint
• Tightening the shoulder capsule by using heat to shrink it or tightening it with sutures (stitches)

Surgery for shoulder instability can either be done using keyhole or open surgery. After the operation, your shoulder will need to be immobilised (prevented from moving) using a special sling for several weeks. You will also need to have physiotherapy to improve your strength. Full recovery may take a number of months.

Read Part 1 Here