J Korean Med Assoc.  2019 Dec;62(12):629-635. 10.5124/jkma.2019.62.12.629.

Diagnosis and non-operative treatment of shoulder pain

• Lee SU

• KMID: 2465357
• DOI: http://doi.org/10.5124/jkma.2019.62.12.629

Abstract

The shoulder is the third most common region in which musculoskeletal pain occurs, involving symptoms that cause a decrease in quality of life and a reduced ability to perform activities of daily life if untreated. Many lesions cause shoulder pain; therefore, we included those commonly encountered in primary care clinics. We aimed to describe the diagnosis and non-operative or conservative treatment modalities of rotator cuff tendinopathy, impingement syndrome, rotator cuff tear, adhesive capsulitis, biceps tendonitis, and acromioclavicular arthritis. Exercise has been reported to be effective for the treatment of impingement syndrome, and the effect of exercise has been shown to reduce pain. Both home-based self-exercise and exercise supervised by professionals are equally effective. Types of exercise should include stretching, active, active-assistive, and resistive exercise. Ten repetitions per set for 3 sets of each exercise should be prescribed initially post-injury. Repetition and resistance should be increased as strength grows. The use of ultrasonography for the diagnosis of shoulder pain has increased recently. Corticosteroid injection under ultrasonographic guidance is effective in reducing pain.

Keyword

Shoulder pain; Conservative treatment; Rotator cuff; Bursitis; Ultrasonography

MeSH Terms

Arthritis
Bursitis
Diagnosis*
Muscle Stretching Exercises
Musculoskeletal Pain
Primary Health Care
Quality of Life
Rotator Cuff
Shoulder Pain*
Shoulder*
Tears
Tendinopathy
Tendons
Ultrasonography

Figure

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  Figure 1 An ultrasonography image indicating tendinopathy of the supraspi-natus tendon.

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  Figure 2 Pendulum exercise for the shoulder. Informed consent was obtained from the study participant.

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  Figure 3 (A) Anterior shoulder stretching exercise. (B) Posterior shoulder stretching exercise. Informed consent was obtained from the subject.

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  Figure 4 (A) Internal and external rotator strengthening exercise using an elastic band. (B) Scaption exercise of the shoulder. Informed consent was obtained from the participant.

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  Figure 5 (A) Chair press. (B) Upright rows. Informed consent was obtained from the participant.

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  Figure 6 Ultrasonography of a supraspinatus tendon tear. (A) Normal tendon. (B) Articular side partial tear. (C) Bursal side partial tear. (D) Full thickness tear.

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  Figure 7 Intraarticular injection in the shoulder under ultrasonographic guidance.

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  Figure 8 Ultrasonographic image of the biceps brachii tendon, transverse plane. (A) Normal. (B) Effusion.

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