Non-surgicaltreatments for shoulder pain

It could be worthwhile looking at non-surgical ways to manage your shoulder pain before having surgery.

Shoulder replacement is usually recommended when the cartilage in your shoulder joint is damaged as a result of injury or degenerative arthritis. This damage causes pain, stiffness and reduced function. There are several alternatives to shoulder replacement surgery, as long as the joint isn’t too badly damaged.

Changing the way you do things

You might be able to address your shoulder pain yourself. You can try to avoid repeating activities that bring the pain on, be sensible about lifting things, address muscle imbalances and sleep in a way that supports your shoulder.

Avoiding certain activities

Repeated activity that involves your shoulder can put more strain on the joint. For example, try and take regular breaks if you’re hammering, sawing, painting or polishing your car. You might also need to stop doing things that bring on pain such as serving in tennis or bowling in cricket.

Careful lifting

Lifting heavy objects can injure your shoulder. Ask for help or use devices to help you do the heavy lifting.

Restoring muscle balance

Many shoulder problems begin with a muscle imbalance, when a muscle becomes stronger than the one that opposes it. This leads to abnormal shoulder function, making the shoulder more susceptible to injury. Improving your core stability and doing specific shoulder-strengthening exercises can help with this. Restoring muscle balance doesn’t help if your pain is caused by arthritis.

Supporting your shoulder

Sleeping with your shoulder supported can take the strain off it. Experiment with using pillows for support and try to find sleeping positions that keep your shoulder in a comfortable position. When you’re travelling, put a pillow under your arm to support it.

Hot and cold packs

If you injure or aggravate your painful shoulder, putting a cold pack on it can help reduce the initial pain and stiffness. Apply the cold pack to your shoulder for 15–20 minutes, every 3 or 4 hours. After a few days, or when things have improved, hot packs or a heating pad may also help.

Medications

There are several oral medications that can help reduce shoulder pain and improve function. The first one you can try is paracetamol.

Your doctor may also recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID). Common NSAIDs have the generic names aspirin, meloxicam, celecoxib, ibuprofen, mefenamic acid, diclofenac, naproxen, piroxicam and ketoprofen. They have a tendency to cause gastric side effects and you should consult your doctor before trying them.

You may need to try more than one NSAID before finding one that works for you.

More powerful analgesics containing opioids such as codeine, oxycodone, morphine or tramadol can be prescribed but they’re not recommended for long-term use due to their side effects, toxicity and potential for addiction.

Topical medications

Creams/ointments containing methyl salicylate, capsaicin, camphor, menthol or eucalyptus oil can help relieve pain by stimulating the nerves near the painful area and interrupting pain signals. Herbal creams often contain these same ingredients, plus herbs as well.

Note: If you’re using painkillers, gels or creams every day, it’s time to see your doctor. Chronic use of painkillers can have adverse effects.

Steroid injection

Your doctor may recommend a corticosteroid injected into your shoulder. It’s possible this will give you relief that lasts for weeks or even months.

Your GP may refer you to a rheumatologist for the steroid injection or to a radiologist where you can have an ultrasound-guided steroid injection. The injection sometimes causes side effects, and can take a while to relieve your pain, so you may need to schedule some time off work or have the injection before a weekend break.

Physiotherapy

A physiotherapist can assess and treat your shoulder pain, giving you a program that includes exercise, stretching and practical advice about how to look after your shoulder.

Massage

Regular massage may ease your shoulder pain, increase its range of motion and help you relax. To be effective, you need to have regular massages by a skilled practitioner. Many physiotherapy practices offer massage therapy.

Acupuncture

An acupuncturist works to relieve pain by inserting fine needles into your skin. The needles are thought to stimulate your body’s production of natural painkilling chemicals. Because the needles are so thin, it’s not usually painful. Some Eastern medicine practitioners, as well as some doctors, chiropractors and osteopaths believe it’s an effective way to treat pain. However, clinical evidence of its effectiveness is limited.

Make sure your acupuncture practitioner is qualified and registered with the Australian Acupuncture and Chinese Medicine Association.

Note: HCF will pay rebates to members with suitable cover who consult qualified physiotherapists, chiropractors, osteopaths, acupuncturists and massage therapists.

Hemi-arthroplasty

This is a partial shoulder replacement where the ball on the top of your arm is replaced, without replacing the socket. Ongoing pain relief after hemi-arthroplasty is generally not as good as total shoulder replacement but in some situations it may be preferable. If you’re very young, or if there are technical reasons for not replacing the socket, your surgeon may recommend hemi-arthroplasty.