Shoulder Pain

Diagnosis/Definition

• 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).

Initial Diagnosis and management

• History and physical exam, to include a careful neurological exam of the upper extremities.
• 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.

Ongoing Management and Objective

• 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.
• 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.

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