Shoulder Pain — Where Are We Now?

Abstract

Purpose of Review Shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified. Recent Findings Imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit. Summary Much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.

Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis

“…Adjunct therapies were considered in combination with ET and not as stand-alone interventions, limiting the conclusions regarding their effectiveness on their own. Usual care group included variable approaches, including advice, wait-and-see and potential use of pain medications; however, in current practice this is a very common pattern [ 92 , 93 ]. The diagnosis criteria were variable among studies, but we used rotator cuff related shoulder pain or undefined shoulder pain terms to address this concern.…”

No Evidence of Short-Term Changes in Muscle Activity Elicited by Dry Needling in Chronic Unilateral Shoulder Pain Patients

“…S houlder pain is considered a highly prevalent musculoskeletal condition. [1][2][3] It constitutes the third most common musculoskeletal symptom, and about 50% of the patients report persistent pain 12 months after its appearance. 4,5 The etiology of this condition is presumably mechanical, although several studies have proposed that sensitization of shoulder muscle afferents contributes to the development of shoulder pain.…”

“…Shoulder pain is considered a highly prevalent musculoskeletal condition 1–3 . It constitutes the third most common musculoskeletal symptom, and about 50% of the patients report persistent pain 12 months after its appearance 4,5 .…”

Extracorporeal Shock Wave Therapy vs. Corticosteroid Local Injection in Shoulder Impingement Syndrome

“…Shoulder pain is one of the most frequent musculoskeletal complaints encountered by clinicians in everyday medical practice following back and knee disorders, and patients of all ages experience it 1,2 . Shoulder disorders lead to deterioration of shoulder joint function, as well as a major decrease in life quality 3 …”

“…Shoulder impingement syndrome (SIS) is the most common shoulder disorder and refers to several conditions that cause primary or secondary impingement 3 . The first form of SIS occurs because of structural (i.e., anatomical) changes that can narrow the subacromial space, which can pinch the structures in this location 4 .…”