Nonsurgical treatment is urged as the primary approach for addressing shoulder pain among athletes, especially those involved in throwing sports, according to a recent study published in the journal Physical Medicine & Rehabilitation Clinics of North America.

The study’s authors starkly point out, “The results of treatment are not as predictable as the patient, family, trainer, coach, and doctor would like to think.” Nickolas Garbis, MD, an orthopedic surgeon who specializes in shoulder and elbow injuries at Loyola University Medical Center, is the primary author.

Overhead throwing generates a large amount of stress on the shoulder, which is one of the most mobile joints in the body. This makes it vulnerable to injury.

The cause of shoulder pain may be difficult to diagnose, since an issue with any of the four joints that comprise the shoulder cause pain. The depth of the structures that make up the shoulder can also make examine by touch difficult. Furthermore, the same kind of pain may be attributed to several causes. Pain in the front of the shoulder can be due to rotator cuff tendinitis, rotator cuff tears, biceps tendinitis, shoulder instability, shoulder stiffness, and several other causes.

“A systemic approach, and some experience, can help the clinician become more familiar with which constellation of findings in these athletes is not normal,” Garbis and co-author Edward McFarland, MD, write.

The authors suggest that treatment should be primarily nonsurgical. Nonsurgical options include icing the shoulder and judicial use of nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen. Rehabilitation can restore a normal muscular balance. Rest can help, but it should not be prolonged because the shoulder could become deconditioned.

If nonsurgical options fail, arthroscopic surgery can be considered. For example, surgical repair or trimming of partial rotator cuff tears can be highly successful, returning as many as 89% of college and professional pitchers back to play. However, the  type of surgery needed depends upon the patient’s shoulder problem.

[Source: Loyola Medicine]