Treatment of Right Shoulder Pain

Initial Assessment

Evaluate tone, strength, soft tissue changes, joint alignment, pain levels, and orthopedic changes in the shoulder 1
Assess for potential causes including adhesive capsulitis, traction/compression neuropathy, complex regional pain syndrome, shoulder trauma, bursitis/tendonitis, rotator cuff tear, or heterotrophic ossification 3
Determine if pain is traumatic or non-traumatic 4
Radiographic evaluation should include anteroposterior views in internal and external rotation and an axillary or scapula-Y view to properly assess alignment and potential fractures 4

Range of motion exercises focusing on external rotation and abduction to prevent frozen shoulder and shoulder-hand pain syndrome 3, 1
Active range of motion should be increased gradually while restoring alignment and strengthening weak muscles in the shoulder girdle 1
Avoid overhead pulley exercises as they encourage uncontrolled abduction and may increase pain 3, 5
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain relief 1
Modalities including ice, heat, and soft tissue massage 3

Intra-articular corticosteroid injections for patients with inflammation or when pain is related to injury of the subacromial region 3, 1
Subacromial corticosteroid injections when pain is thought to be related to rotator cuff or bursa inflammation 1
Shoulder strapping or slings for support, especially if there is subluxation 3, 6
Functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES) may be considered for shoulder pain 3, 5

Botulinum toxin injections into the subscapularis and pectoralis muscles when shoulder pain is related to spasticity 5, 1
Suprascapular nerve blocks may be considered as an adjunctive treatment for persistent shoulder pain 7, 5

For Complex Regional Pain Syndrome (CRPS), an early course of oral corticosteroids can reduce swelling and pain 1
Positioning and use of supportive devices should be considered for shoulder subluxation 5
Patient and family education on proper positioning and range of motion exercises is essential, particularly before discharge or transitions in care 5