Shoulder Pain: Assessment & Treatment

Shoulder pain can range from mild discomfort during specific movements to unbearable pain even at rest. For the assessment, it is important to establish whether the pain is triggered by movement, which specific movements provoke it, how long it takes to settle, or whether it persists — and for how long — at rest. It is also important to determine whether there is night pain and how long it lasts. Shoulder pain can have the following characteristics:

• Sharp

• Stabbing

• Throbbing

• Burning

• Electric-shock-like

• Superficial

• Deep

• Mild

• Dull

• Constant

• Intermittent

When shoulder pain appears, the immediate steps to take are:

• Rest the arm and avoid the activity that is causing the pain

• Apply ice to the shoulder, over the painful area, for 15–20 minutes, 2–3 times a day (the ice should be wrapped in a towel)

• Gentle stretches of the shoulder, elbow, wrist and fingers help to maintain the flexibility of the arm

Assessment by a Physiotherapist is essential in order to identify the structures involved and to rule out — or confirm — the coexistence of other conditions that present with similar symptoms, such as:

• Impingement Syndrome

• Frozen Shoulder

• Supraspinatus Tendinopathy

• Calcific Tendinopathy

• Shoulder Dislocation

• Bursitis

• Joint pathology

• Fracture

The assessment by Orthopaedic Manipulative Physiotherapist Mr Konstantinos Danalis is carried out through a detailed case history, clinical tests, and a trial treatment that follows.

The priority is to reduce pain, which in some patients can be extremely acute. This is achieved through a combination of treatment options such as specialist massage and electrotherapy, which will reduce pain in every case. The shoulder is then mobilised with specialist exercises. As range of movement gradually increases, shoulder strengthening exercises are introduced; over time, these restore correct movement and positioning of the shoulder blade, increase the space beneath the acromion — which the tendons and other shoulder structures need in order to lift the arm — and allow the arm to move freely without causing a recurrence. The interventions applied are:

• Stretches and stretching exercises to improve flexibility

• Dynamic shoulder stability through strengthening

• Orthopaedic Manipulative Physiotherapy to reduce pain and improve flexibility

• Electrophysical modalities such as diathermy, cryotherapy and electrotherapy, to reduce pain and inflammation

• TECAR for deep tissue heating and to accelerate shoulder rehabilitation

Verified user

He examined my neck thoroughly, was very thorough in his explanations and helped me understand what I was dealing with. He truly understood how much this pain was affecting my daily life. He helped me effectively — I trust him completely.

Verified user

He dedicated a great deal of time to the neck pain that had been troubling me for a long time. I am already feeling much better just one day later. I will continue with the treatments — he is an excellent professional with a wealth of knowledge. I recommend him wholeheartedly.

Verified user

Mr Danalis paid great attention to the pain I have in my shoulder. I am already feeling much better and will continue with the treatments as he recommended! An excellent professional with a wealth of knowledge. I recommend him wholeheartedly!

To prevent shoulder pain in patients with chronic problems, a monthly programme is required that includes:

• Orthopaedic manipulative massage

• A structured exercise programme

Further advice on prevention and self-management can be found at the links below:

• Recomendations for Patients by American Physical Therapy Association

The cost of treatment is not high. Typically, 6 sessions are required, in which the treatment programme is tailored each time to the patient's current condition. Once symptoms have settled, a structured exercise programme is introduced to prevent any recurrence. The programme is provided to the patient electronically so that they can follow it independently, with the option of online supervision also available at a low cost. The patient has the ongoing support and communication they need with the Physiotherapist in order to address any difficulties.

If you have Shoulder Pain, call PhysioDanali today for specialist advice from your Physiotherapist!

• Pieters L, Lewis J, Kuppens K, et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther. 2020;50(3):131-141. doi:10.2519/jospt.2020.8498

• Lafrance S, Charron M, Roy JS, et al. Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 2022;52(10):647-664. doi:10.2519/jospt.2022.11306

• Dyer JO, Doiron-Cadrin P, Lafrance S, et al. Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: Clinical Practice Guideline Methods. J Orthop Sports Phys Ther. 2022;52(10):665-674. doi:10.2519/jospt.2022.11307