Chronic shoulder pain: part II. Treatment.
Chronic shoulder pain is a common problem in the primary care physician's office. Effective treatment depends on an accurate diagnosis of the more common etiologies: rotator cuff disorders, adhesive capsulitis, acromioclavicular osteoarthritis, glenohumeral osteoarthritis, and instability. Activity modification and analgesic medications comprise the initial treatment in most cases. If this does not lead to improvement, or if the initial presentation is of sufficient severity, a trial of physical therapy that focuses on the specific diagnosis is indicated. Combined steroid and local anesthetic injections can be used alone or as an adjuvant to the physical therapy. The site of the injection (subacromial, acromioclavicular joint, or intra-articular) depends on the diagnosis. Injections into the glenohumeral joint should be done under fluoroscopic guidance. Symptoms that persist or worsen after six to 12 weeks of directed treatment should be referred to an orthopedic specialist.
Burbank
Kelton M
KM
Longview Orthopaedic Center, HealthAlliance Hospital, Leominster, Massachusetts 01453, USA. kmbortho1@aol.com
Stevenson
J Herbert
JH
Czarnecki
Gregory R
GR
Dorfman
Justin
J
D000700:Analgesics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D012017:Referral and Consultation; D020069:Shoulder Pain / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome
D000700:Analgesics