What can we expect from nonoperative treatment options for shoulder pain?

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What can we expect from nonoperative treatment options for shoulder pain?

J Fam Pract. 2005 March;54(3):216-223

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References

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TABLE 4
Nonoperative treatments for SIS III (full-thickness rotator cuff tears)

Treatment	Comment	SOR
Physical therapy	Patient satisfaction is best correlated with improved pain Functional abilities significantly improved These improvements are seen over years	B
Subacromial injection	• Accurate delivery is key	B
Multiple nonoperativetherapies	Active abduction and strength significantly improve Relief of discomfort more likely if pain has been present for less than 3 months	B

Adhesive capsulitis

There is no consistent evidence that treatment of any one form reduces the pain or improves range of motion in frozen shoulders. Various treatments that have been tried include, though are not limited to, steroid injection, NSAIDs, and physical therapy.^33-37 Studies on treatment efficacy are complicated by inherent discrepancy between patient and observer opinions of limitations in this condition, with objective range of motion findings often not being consistent with patient reported limitations.³⁸

Indicators of quicker or slower recovery

Studies of prognosis following treatment have been difficult to assess due the heterogeneity of the underlying conditions and variability of treatments. A follow-up questionnaire in one instance found no difference between treatment groups. Complaints of pain or impaired mobility 2 to 3 years after treatment were similar among patients treated with steroid injection and physical therapy and with physical therapy alone.³⁰ Overall, 76% of respondents were symptom free at 2 to 3 years.

Two prospective studies confirm that speed of recovery is slow, with complete recovery 23% at 1 month, 21% to 51% at 6 months, 59% at 1 year, and 69% at 18 months.^39,40

Prognostic indicators of quicker recovery were preceding overuse or slight trauma and early presentation to the physician.⁵⁸ Protracted recovery occurred more often with high pain levels during the day or associated neck pain.⁵⁸ These results suggest that patients with subacromial impingement stage I respond better to nonoperative treatment than those patients with underlying degenerative changes or referred pain from the neck.

Finally, specialty surgical referral may be necessary in cases of failed nonoperative therapy or persistent diagnostic and therapeutic challenges.

Corresponding author
Thomas H. Trojian, MD, 99 Woodland Street, Hartford, CT 06105. E-mail: ttrojian@stfrancsicare.org.