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Shoulder Pain

Shoulder Pain

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