Shoulder pain is defined as soreness, tension, and/or stiffness in the anatomical region of the shoulder and can be secondary to multiple conditions including, but not limited to rotator cuff tendonitis and adhesive capsulitis.

Diagnosis

Diagnosis of shoulder pain is derived mainly from the patient’s history and physical exam with no indicators of potentially serious pathology. Imaging studies are confirmatory for diagnoses of rotator cuff tendonitis, osteoarthritis, glenohumeral instability, and other pathologic causes of shoulder pain [127].

Evidence based summary for manual therapy [53]

The highest level of scientific studies show that there is moderate quality evidence (on a scale of low/moderate/high) that high-grade mobilization is superior to low grade mobilization for reduction of disability, but not for pain, in adhesive capsulitis [129]. There is also moderate evidence that favours the addition of manipulative/mobilization to medical care for shoulder girdle pain and dysfunction [128].

There is RCT evidence that manipulation to the base of the neck and ribs can help shoulder pain relative to usual medical care [128].

Other effective non-invasive physical treatments or patient education

Exercise therapy [130].

Back-in-Action clinical comment

Chiropractic assessment and treatment of shoulder problems is initially aimed at pain relief. In the long-term optimising the strength and length of shoulder muscles and improving shoulder position are important.

In our experience treating the symptoms and underlying causes of tendonitis benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates careful spinal manipulation, mobilisation, muscle release techniques, cross friction techniques to tendons, cranial work, neck and shoulder exercises, referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling. Modification of any work or sport related activities that aggravate the problem is also essential.

If there is no response to a course of chiropractic treatment, referral for surgical management may be considered.