Your initial evaluation will typically include x-rays, a physical exam, and some cases may require advanced imaging such as an MRI or CT scan to confirm the diagnosis. The x-rays are used to evaluate the bone structure and bony anatomy of the shoulder. A physical examination will help determine the source of pain and identify limitations in range of motion or strength. Advanced imaging is used to provide a higher level of detail that is not able to be appreciated on plain x-rays. All of these are used in combination to provide the best treatment options for your specific condition.

Your treatment plan will be based on the origin of your pain. Depending on where you feel the pain, and other clues from your history and physical exam, the source of your pain can be determined. Important considerations include:
Location: Is the pain coming from the front, the side, or the top of the shoulder?
Difficulty Sleeping: Are you able to sleep on the shoulder? Does the pain keep you from falling asleep or wake you up in the middle of the night?
Activity Related: Are your symptoms present when you perform overhead activities or when trying to reach behind your back?
Additionally, there are certain symptoms that may suggest different diagnoses. For example, weakness with motion can indicate a rotator cuff tear. Instability in the shoulder may point to a labral tear. Pain in the front of the shoulder may relate to inflammation and irritation of the biceps tendon. The biceps tendon is the most common source of shoulder pain. Pain on top of the shoulder when reaching across the body can arise from injury to the AC joint. Frozen shoulder (adhesive capsulitis) is another common condition in the shoulder. Patients with frozen shoulder typically experience pain and stiffness in the shoulder. Though painful at first, frozen shoulder typically improves without surgical intervention.

Initial conservative treatment typically provides significant relief for most shoulder conditions. When dealing with an injury to the shoulder, conservative treatment may provide improvements in strength and motion, allowing you to compensate for the injury and improve overall shoulder function. With the appropriate muscular training and activity modification, symptoms can often be relieved completely, allowing many patients to return to their desired level of activity without ever needing surgery.
The following information includes some of the options we encourage patients to try when first presenting with shoulder pain:

Anti-inflammatory Medications

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are utilized as first line treatment, primarily when treating mild to moderate pain associated with inflammation. Inflammation in joints and tendons can occur after an injury, accident, or repetitive use of the joint. Sometimes inflammation may occur for no reason at all. In these cases, NSAIDs may help to reduce the inflammation significantly, resulting in pain relief. Appropriate dosage of medication is important to know in order to minimize side effects. Additionally, they should not be taken for an extended duration, as they can lead to further systemic problems.

Physical Therapy

Physical therapy is a critical component in the treatment of shoulder pain.  Physical therapy can address several areas to help minimize and sometimes completely relieve shoulder pain. With guidance from a skilled physical therapist who specializes in shoulder pathology, PT can help strengthen muscles around the shoulder, increase flexibility, maintain or improve range of motion, decrease inflammation of the joint or tendons of the shoulder, and correct shoulder or upper back postures that might be contributing to your overall pain. Consistency with conditioning and strengthening exercises for the muscles that stabilize the shoulder can allow for significant improvement in symptoms.

Injection Therapy

Injections are a reasonable conservative treatment option to consider when struggling with shoulder pain. They can serve diagnostic as well as therapeutic purposes. Two main benefits of injections are:
Helping to diagnose the exact source of the pain. This type of injection is called a diagnostic shoulder injection.
Helping to treat the pain by decreasing inflammation within the joint or tendons surrounding the shoulder joint.

Diagnostic Shoulder Injections

A local anesthetic (lidocaine) is injected directly into the shoulder joint. The anesthetic typically takes effect within a minute or two. If you experience pain relief, or at least a reduction in more than 50% of the pain, immediately following the injection, it confirms the shoulder joint as the actual source of pain. For example, if pain is coming from inside the joint (cartilage, labrum), an injection within the joint will help with the pain. However, if there is inflammation in the subacromial space (above the rotator cuff) pain might not improve.

Pain Relieving Injections

Beyond diagnosis, injections can be an important tool in the treatment of shoulder pain. Cortisone, hyaluronic acid, or platelet rich plasma (PRP) injections placed directly into the shoulder joint can provide symptomatic relief. After an injection, the medication will spread throughout the shoulder, maximizing therapeutic outcomes. Pain relief varies from patient to patient, with some patients feeling relief within two to five days. However, if a patient does not experience improvement by ten days following the injection, they are unlikely to gain any additional improvement with time and further diagnostic testing may be needed to identify other options for relief.

When inflammation to the biceps tendon is thought to be the source of pain, an injection to the biceps sheath is often prescribed. An ultrasound may be used to help guide the provider in administering the injection directly into the biceps sheath.

Injections of the acromioclavicular (AC) joint are often prescribed when arthritis and inflammation affect the AC joint. Similar to a biceps sheath injection, an ultrasound may be used to help guide the provider in administering the injection directly into the AC joint.