Shoulder pain can come from different sources such as the tendon, bursa, joint, or referred from another region of the body. Common shoulder diagnoses include subacromial pain syndrome, frozen shoulder, shoulder instability, arthritis, and myofascial pain. Subacromial pain syndrome includes tendonitis, bursitis, rotator cuff tears and impingement syndrome. Referred pain could come from the neck, an infection, cancer, or visceral (organ) pathology.
Research has indicated successful treatment of shoulder conditions involves the understanding of tissue irritability (pain level) and the degree of impairment (mobility, strength and endurance). The physical therapy evaluation will include the assessment of the neck and upper back regions, shoulder and shoulder girdle (shoulder blade region) strength and mobility. The treatment plan may involve joint mobilization, soft tissue mobilization, trigger point dry needling, and exercises to improve shoulder strength and endurance. Exercise may be instructed to address shoulder ROM/mobility, shoulder blade muscular strength, control and mobility, neck and upper back ROM/mobility, and rotator cuff strength and endurance.
An important component of the treatment plan is dosage. Dosage is applying the appropriate level of exercise intensity for the specific condition. In addition, the type of exercises can also effect recovery. An assessment of the level of tolerance to physical therapy intervention is an important component to successful treatment. This assessment is performed during individual sessions as well as between sessions. Although the source of shoulder pain may be similar between individuals, treatment variables may need to be adjusted to meet their specific condition.