Shoulder pain, with or without symptoms of instability, stiffness, weakness, catching, crepitus, deformity, or paresthesias, not associated with acute fracture, in the absence of cervical spine or non-skeletal etiologies (such as cardiac or neurogenic).
Shoulder Pain : Initial Diagnosis and Management
- History and physical exam, to include a careful neurological exam of the upper extremities for shoulder pain.
- AP and axillary x-ray views of the shoulder are indicated as part of the initial diagnostic work up.
- MRI/CT/arthrogram not indicated as part of initial diagnostic work up.
- Diagnostic or therapeutic injection of local anesthetic and steroid, documenting site of injection (e.g. AC, subacromial, bicipital groove), type and amount of Rx.
- Sling and swathe (limited to maximum of 7 days).
- NSAIDs, appropriate use of light narcotic Rx for no more than 7 days in acute injuries.
- Activity modifications as required for shoulder pain.
Shoulder Pain : Ongoing Management and Objectives
- With the above plan and associated algorithm leading to diagnosis and treatment, resolution is expected in 3-4 weeks. A specific diagnosis can be treated as above for 3-4 months, as long as slow improvement is occurring. Light narcotics only indicated for a short period after an acute injury or re-injury of shoulder pain.
- If no improvement has occurred within 4 weeks, referral to specialty care is indicated. Adjunctive studies other than x-rays are most appropriately ordered by the specialty care provider or after phone consultation recommendation.
Shoulder Pain : Indication a profile is needed
- Any limitations that affect strength, range of motion, and general efficiency of upper arm, shoulder girdle, and upper back, including cervical and thoracic vertebrae.
- Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent hand-to-hand fighting and disqualifies for prolonged effort.
- Defects or impairments that require significant restriction of use
Shoulder Pain : Specifications for the profile
- Week 1-4
- No upper body PT
- No overhead activities
- Limited lifting
- No ruck