If your shoulder pain doesn’t improve with simple medications, other treatments are available. Your doctor will be able to give more specific advice.
Physiotherapy and occupational therapy
Most shoulder problems will benefit from physiotherapy. A physiotherapist will assess your condition and put together a tailored treatment programme.
The aim of physiotherapy is to improve symptoms and restore function. The approach will depend on whether you have a short-term (acute) problem or a long-standing (chronic) condition. Almost everyone will benefit from a physiotherapy programme, which might include:
- exercises to strengthen weakened muscles, change their co-ordination and improve function
- advice on improving shoulder, neck and spine posture
- exercises to ease or prevent stiffness
- exercises to increase the range of joint movement
- applying adhesive tape to the skin to reduce the strain on the tissues and to help increase your awareness of the position of the shoulder and shoulder blade
- manual treatments to the soft tissues and joints.
If your shoulder problem is making daily activities - such as dressing, washing and driving - difficult, it may help to see an occupational therapist. They may recommend aids or gadgets, or different ways of doing things, to reduce the strain on your shoulder. Your GP or hospital consultant can refer you for occupational therapy, or you can refer yourself.
If you’re having problems at work, speak to an occupational therapist or the occupational health team if there's one at your workplace. Otherwise, contact your local Jobcentre Plus office to speak with a Disability Employment Adviser.
Steroid injections into the joint can help shoulder problems. The steroid is usually given along with a local anaesthetic, and you should find your shoulder pain improves quite quickly.
The injections reduce inflammation and allow you to move your shoulder more comfortably, though you shouldn’t use your shoulder for anything too strenuous the first two days after an injection. The pain relief should allow you to do your physiotherapy exercises more easily.
Repeated injections (more than two or three) aren’t usually recommended. If the problem keeps coming back, your doctor will probably suggest other treatments or further investigation.
Sometimes the pain may be worse for a short time after the injection but this doesn't mean it has gone wrong. You only need to seek advice if the pain continues for more than a day or so after the injection.
Injections may be carried out with the aid of ultrasound images. These allow the inflamed tissues to be seen on a monitor so injections can be directed precisely.
Most shoulder problems improve without the need for surgery. But some conditions can be helped by surgery.
If an operation is needed it can often be performed using keyhole techniques, which require a smaller incision, and often reduce the recovery time needed. Surgeries include:
- subacromial decompression (see figure below), which involves trimming bone and tissue from the underside of the acromion at the top of the shoulder. This can be helpful for severe or recurrent impingement syndrome by giving space for the rotator cuff tendons to move freely
- repairing tears in the rotator cuff
- releasing the tight capsule of a frozen shoulder.
Conventional open surgery (i.e. not keyhole surgery) may be necessary in some circumstances, for example to repair larger tears in the rotator cuff or for joint replacements.
Shoulder joint replacement is well established and can be successful, particularly for osteoarthritis and rheumatoid arthritis, when severe pain restricts movement and use of the shoulder.
There is also a newer type of shoulder operation called a Reverse Geometry Shoulder replacement. In this procedure the ball and socket are reversed. This is needed if your rotator cuff tendons are damaged as a result of arthritis.
Physiotherapy and exercise are important after surgery to help regain movement, although you may not regain full range of movement or strength after a total shoulder replacement.
Research into developing better ways of treating shoulder pain is taking place at Arthritis Research UK's National Primary Care Research Centre at Keele University.