Question

Treatment plan for shoulder pain– include recommended treatment – cite national guidelines

Answer 1

1) Ans)

Physical discomfort of the shoulder, including the joint itself or the muscles, tendons and ligaments that support the joint andCompromised shoulder movement due to pain, stiffness, or weakness can cause substantial disability and affect a person's ability to carry out daily activities (eating, dressing, personal hygiene) and work.

A functional holistic approach to shoulder pain, including adequate analgesia, is important to motivate patients and encourage rehabilitation. However, the evidence for common primary care interventions, including steroid injections, is relatively weak.The general practitioner should decide whether the pain is arising from the shoulder; if it is from elsewhere, the patient should be treated and referred appropriately.

Treatment:

The goal of treatment is to reduce pain and improve ROM, thus restoring function to the shoulder.

Pain  Nonspecific Shoulder PainTreatment  General Measures  Menu of Additional Therapeutic Options  Condition-Specific Treatment    SIS/RCD, subacromial bursitis    Rotator cuff tear    Adhesive capsulitis    Osteoarthritis of the glenohumeral joint, Nonspecific shoulder pain/dysfunctionManagement Education  Prevention

General Measures:

Analgesics: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly recommended for the treatment of shoulder pain because of their anti-inflammatory effects. Experience suggests that any commonly used oral analgesics can be used for the treatment of shoulder pain thought to be due to RCD, SIS, AC joint disease, or adhesive capsulitis. There have been no studies comparing oral over-the-counter or prescription acetaminophen with NSAIDs. Thus either can be used, depending on coexistent disease and provider and patient preference.

Should patients put ice or heat on their shoulder? Ice has traditionally been recommended for painful muscles and joints.There is little evidence to show whether ice is effective or even counterproductive in the treatment of soft-tissue inflammation. Ice does produce analgesia. Recommend ice for 20 to 30 minutes as often as every 2 hours if it provides relief to the patient. Ice should not be used before vigorous exercise. If ice is not helpful, the patient can try heat.

Activity and work modification: Patients should limit activities that exacerbate their discomfort, especially overhead movements.

Physical therapy: Therapists often use a combination of modalities, which can include manual mobilization, ice, heat, ultrasonography, massage, supervised progressive resistance exercises, electric stimulation, acupuncture, and stretching.

Exercise therapy: Exercise therapy is generally initiated by a physical therapist. The patient is given instruction on strengthening exercises with movements against gravity and then progressive resistance exercises. The patient then follows a self-management plan at home.

Manual therapy: Joint and soft-tissue mobilization and manipulation. Manual therapy is thought to break down the adhesions that form between different layers of soft tissue and allow unimpeded movement of the muscle. It can be used alone or in combination with exercises.

Acupuncture: Needles are placed into specific acupuncture points. Sessions typically last 30 to 60 minutes and are performed 1 to 2 times a week for 4 to 8 weeks. Acupuncture can reduce pain, allowing the patient to participate in exercise therapy.

Subacromial corticosteroid injection: The injection can be guided by ultrasound or by clinical landmarks. There is no difference in safety or efficacy with either approach.The routine use of ultrasound-guided glucocorticoid injection is discouraged, given the excess cost. Patients should not engage in heavy lifting for 2 weeks following an injection.

Platelet-rich plasma injection: Injection of autologous platelet-rich plasma into the subacromial space. There is no evidence that platelet-rich plasma injections in addition to exercise improve pain or function of the shoulder to a greater extent than exercise alone.

Immobilization should be avoided unless directed by a surgeon for fracture.

Botulinum toxin: Intramuscular injection of botulinum toxin A, which may be useful in reducing shoulder pain after stroke and in osteoarthritis of the shoulder

EDUCATION:

In addition to the specific treatment of shoulder pain, patients should be educated on the cause of their problem and the role of each of the modalities used in treatment. Failure to engage in self-management, particularly rehabilitation exercises, can significantly delay or prevent full return to function.

PREVENTION:

Many shoulder problems are due to repetitive motion with the arms or the lack of strength and mobility. Patients with work-related symptoms should undergo an ergonomic review at work to reduce the risk of persistent problems. All patients should be encouraged to incorporate upper extremity ROM and strengthening to their overall fitness routine

- Exercise can significantly reduce pain and improve function.Recommended exercises run the gamut from nonspecific shoulder strengthening to exercises designed to correct the mechanical issues leading to impingement.

- Exercise therapy can be supervised as part of regular visits to a physical therapist, or done independently by the patient at home as part of a self-management plan.

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