Journal List > J Korean Med Assoc > v.62(12) > 1139226

Lee: Diagnosis and non-operative treatment of shoulder pain

Abstract

The shoulder is the third most common region in which musculoskeletal pain occurs, involving symptoms that cause a decrease in quality of life and a reduced ability to perform activities of daily life if untreated. Many lesions cause shoulder pain; therefore, we included those commonly encountered in primary care clinics. We aimed to describe the diagnosis and non-operative or conservative treatment modalities of rotator cuff tendinopathy, impingement syndrome, rotator cuff tear, adhesive capsulitis, biceps tendonitis, and acromioclavicular arthritis. Exercise has been reported to be effective for the treatment of impingement syndrome, and the effect of exercise has been shown to reduce pain. Both home-based self-exercise and exercise supervised by professionals are equally effective. Types of exercise should include stretching, active, active-assistive, and resistive exercise. Ten repetitions per set for 3 sets of each exercise should be prescribed initially post-injury. Repetition and resistance should be increased as strength grows. The use of ultrasonography for the diagnosis of shoulder pain has increased recently. Corticosteroid injection under ultrasonographic guidance is effective in reducing pain.

Figures and Tables

Figure 1

An ultrasonography image indicating tendinopathy of the supraspi-natus tendon.

jkma-62-629-g001
Figure 2

Pendulum exercise for the shoulder. Informed consent was obtained from the study participant.

jkma-62-629-g002
Figure 3

(A) Anterior shoulder stretching exercise. (B) Posterior shoulder stretching exercise. Informed consent was obtained from the subject.

jkma-62-629-g003
Figure 4

(A) Internal and external rotator strengthening exercise using an elastic band. (B) Scaption exercise of the shoulder. Informed consent was obtained from the participant.

jkma-62-629-g004
Figure 5

(A) Chair press. (B) Upright rows. Informed consent was obtained from the participant.

jkma-62-629-g005
Figure 6

Ultrasonography of a supraspinatus tendon tear. (A) Normal tendon. (B) Articular side partial tear. (C) Bursal side partial tear. (D) Full thickness tear.

jkma-62-629-g006
Figure 7

Intraarticular injection in the shoulder under ultrasonographic guidance.

jkma-62-629-g007
Figure 8

Ultrasonographic image of the biceps brachii tendon, transverse plane. (A) Normal. (B) Effusion.

jkma-62-629-g008

Acknowledgement

Special thanks to Sang Yoon Lee, MD, PhD and Jung Woo Kim, MD (Seoul National University Boramae Medical Center, Depart-ment of Physical Medicine & Rehabilitation) for the help on the photographs in the article.

Notes

Conflict of Interest No potential conflict of interest relevant to this article was reported.

References

1. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998; 57:649–655.
crossref
2. Laslett LL, Burnet SP, Jones JA, Redmond CL, McNeil JD. Musculoskeletal morbidity: the growing burden of shoulder pain and disability and poor quality of life in diabetic outpatients. Clin Exp Rheumatol. 2007; 25:422–429.
3. Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983; (173):70–77.
crossref
4. Bigliani LU, Levine WN. Subacromial impingement syndrome. J Bone Joint Surg Am. 1997; 79:1854–1868.
5. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician. 2008; 77:453–460.
6. Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Baños J, Martin-Mola E. Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis. 2002; 61:132–136.
crossref
7. Arroll B, Goodyear-Smith F. Corticosteroid injections for painful shoulder: a meta-analysis. Br J Gen Pract. 2005; 55:224–228.
8. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009; 18:138–160.
crossref
9. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972. J Bone Joint Surg Am. 2005; 87:1399.
crossref
10. Murrell GA, Walton JR. Diagnosis of rotator cuff tears. Lancet. 2001; 357:769–770.
crossref
11. Burk DL Jr, Karasick D, Kurtz AB, Mitchell DG, Rifkin MD, Miller CL, Levy DW, Fenlin JM, Bartolozzi AR. Rotator cuff tears: prospective comparison of MR imaging with arthrography, sonography, and surgery. AJR Am J Roentgenol. 1989; 153:87–92.
crossref
12. Jacobson JA. Fundamentals of musculoskeletal ultrasound. 2nd ed. Philadelphia: Elsevier/Saunders;2013.
13. Redler LH, Dennis ER. Treatment of adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2019; 27:e544–e554.
crossref
14. Arkkila PE, Kantola IM, Viikari JS, Rönnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis. 1996; 55:907–914.
crossref
15. Lee HJ. Differential diagnosis of common shoulder pain. J Korean Med Assoc. 2014; 57:653–660.
crossref
16. Nam HS, Lee SU. Conservative management of shoulder pain with common causes. J Korean Med Assoc. 2014; 57:661–666.
crossref
17. Rizk TE, Gavant ML, Pinals RS. Treatment of adhesive capsulitis (frozen shoulder) with arthrographic capsular distension and rupture. Arch Phys Med Rehabil. 1994; 75:803–807.
crossref
TOOLS
ORCID iDs

Shi-Uk Lee
https://orcid.org/0000-0003-0850-5217

Similar articles