Shoulder Pain: Conservative Treatment Versus Surgical Intervention | Blog

Shoulder Pain: Conservative Treatment Versus Surgical Intervention

  Posted: Feb 08, 2020

  Category: MD Newsletter


Shoulder pain is one of the most prevalent forms of musculoskeletal pain, affecting upward of 20% of the population. Shoulder pain comprises a number of categories, including chronic shoulder pain (pain lasting six months or more), pain or loss of range of motion (ROM), pain that comes as a result of a rotator cuff disorder, shoulder instability, arthritis, adhesive capsulitis (frozen shoulder), and shoulder impingement syndrome (SIS, swimmer’s shoulder), among others.
 
Because shoulder pain and loss of ROM is so prevalent, a significant body of research has developed and determined that the best course of action in developing a treatment plan to address shoulder pain and loss of ROM is using conservative treatment methods over surgical intervention.
 
In fact, more and more research suggests that surgical intervention is not needed or recommended for a large number of shoulder pain cases. However, for some select cases in which conservative treatments fail or are unresponsive, surgery may be recommended by the physician. That being said, in all cases, shoulder pain and shoulder ROM issues should first be approached from a conservative medical methodology.
 
Patients with rotator cuff tearing, for example, have been found to benefit from daily stretching and strengthening exercises as directed by a physical therapist. These treatments contribute to short-term recovery and long-term improved function.
 
Further research into conservative treatment supports this. Treatment can include exercise therapy (including strength and ROM exercises) and passive joint mobilization, which has
been recognized for successful rehabilitation of chronic shoulder pain patients. Other conservative treatments include electrophysical modalities and corticosteroid injection.
 
In one analysis of conservative treatment, 82 subjects with chronic shoulder pain were treated with the four treatments mentioned above. The study resulted in the subjects noting
“significant improvement,” with 88% reporting improved shoulder function and a 63%–98% improvement in pain.
 
Another study looked into the efficacy of kinesio tape, which is a popular option among athletes. Kinesio tape has increased in popularity among clinicians as a method to improve pain-free ROM. However, research has found that kinesio tape is not effective as a sole treatment but is significantly more effective in concert with a therapy plan. Additionally, while kinesio tape can successfully restore ROM, it is not useful as a method to decrease pain intensity.
 
Shoulder impingement syndrome (SIS), however, has been a source of major debate among physical therapists and surgeons. SIS has several symptoms resulting from the compression of structures around the glenohumeral joint. Pain stemming from SIS is often described as severe, and the musculoskeletal weakness results in limited ROM.
 
While surgery can be an effective option for SIS patients, the first option of conservative treatment, specifically exercise therapy, cannot be discounted. While operative treatment is noted as being successful in reducing pain and restoring ROM, the difference in results — surgery versus manual therapy — is not significant enough to warrant the surgical option until the patient has tried manual therapy and did not experience positive results.
 
Based on the current body of research, the general consensus is to use conservative methods (i.e. exercise therapy) ahead of surgical intervention to treat shoulder pain. Only after conservative treatment has been administered and the patient and physician agree surgical intervention is the best option should surgery be pursued. By making surgery a secondary option, in most cases, the patient can avoid complications associated with surgery (additional pain, healing time, and further rehabilitation), while still achieving the same or similar results in a similar time frame.


Sources: 
Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic Shoulder Pain: Part I. Evaluation and Diagnosis. American Family Physician. 2008;77(4):453-460.
 
Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic Shoulder Pain: Part II. Treatment. American Family Physician. 2008;77(4):493-497.
 
Thelen MD, Dauber JA, Stoneman PD. The Clinical Efficacy of Kinesio Tape for Shoulder Pain: A Randomized, Double-Blinded, Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy. 2008;38(7):389-395 doi: 10.2519/jospt.2008.2791
 
Ginn KA, Cohen ML. Conservative treatment for shoulder pain: Prognostic indicators of outcome. Archives of Physical Medicine and Rehabilitation. 2004;85(8):1231–1235. doi:10.1016/j.apmr.2003.09.013
 
Don W, Goost H, Lin X-B, et al. Treatments for Shoulder Impingement Syndrome. Medicine. 2016;95(23). doi:10.1097/01.md.0000484495.36196.d5
 
Simons SM, Kruse D, Dixon JB. Shoulder impingement Syndrome. UpToDate. https://www.uptodate.com/contents/shoulderimpingement-syndrome#! Published October 4, 2017. Accessed October 4, 2019.