Guidelines - Shoulder Pain

This tool provides information to facilitate the management of recent onset and persistent shoulder pain for adults.

Focused examination

1. Patient History 

  • Rule out major structural or other pathologies. If required, refer to an appropriate healthcare provider​.

  • Identify and assess other conditions and co-morbidities. Manage using appropriate care pathways.

  • Address prognostic factors that may delay recovery.

Major structural or other pathologies (red flags):

  • unexplained deformity or swelling or erythema of the skin, significant weakness not due to pain, past history of malignancy, suspected malignancy (e.g., weight loss or loss of appetite), fever/chills/malaise, significant unexplained sensory/motor deficits, pulmonary or vascular compromise, inability to perform any movements, pain at rest

Examples of other conditions/co-morbidities:

  • Physical conditions: back pain, headache

  • Psychological symptoms: depression/anxiety

  • Co-morbidities: diabetes, heart disease

Examples of prognostic factors that may delay recovery:

  • Symptoms of depression or anxiety, passive coping strategies, job dissatisfaction, high self-reported disability levels, disputed compensation claims, somatization

2. Physical Examination

  • Rule out major structural or other pathologies​.

  • Assess for neurological signs.

  • Identify type of shoulder pain.

Soft tissue shoulder pain: includes grades I and II sprains or strains, tendinitis, bursitis and impingement syndrome affecting the gleno-humeral and acromio-clavicular joints


Shoulder pain with calcific tendinitis: shoulder pain, as indicated above, with calcific tendinitis

3. Management 

  • Offer information on nature, management, and the course of shoulder pain. See patient handouts for more information to provide to patients.

  • Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.

Patient Handouts

CCGI_patient information_shoulder.jpg
CCGI_shoulder pain_patient handout - FRE
 

Management of recent onset (0-3 months) shoulder pain

 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider low-level laser therapy

  • Consider spinal manipulation and mobilization

  • Consider multimodal careᶧ

    • combination of heat/cold, joint mobilization, range of motion exercise

  • Do not offer diacutaneous fibrolysis

  • Do not offer ultrasound

  • Do not offer interferential current therapy

Management of persistent (4-6 months) shoulder pain

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:

  • Consider low-level laser therapy

  • Consider strengthening and stretching exercises (can be combined and supervised)

  • Consider usual physician care including information, pain-contingent medical or pharmaceutical therapy

  • Consider spinal manipulation and mobilization as an adjunct to usual care for shoulder pain with associated pain or restricted movement of the cervico-thoracic spine

  • Consider multimodal careᶧ

    • combination of heat/cold, joint mobilization, range of motion exercises

  • Do not offer diacutaneous fibrolysis

  • Do not offer shock-wave therapy

  • Do not offer cervical mobilizations (alone)

  • Do not offer multimodal careᶧ that includes the combination of exercise, mobilization, taping, psychological interventions, massage

  • Do not offer ultrasound

  • Do not offer interferential current therapy

Management of shoulder pain with calcific tendinitis 

Provide structured patient education (advice to stay active, reassurance, promote and facilitate return to work and normal activities, self-care advice) and the following therapeutic intervention*:

  • Consider shock-wave therapy with an amplitude ranging from 0.08mJ/mm²-0.06mJ/mm²

*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
ᶧMultimodal care: treatment involving at least two distinct therapeutic modalities, provided by one or more health care disciplines.

Care Pathway for the management of

shoulder pain

(click here for French version)

Care pathway for the management of shoulder pain with calcific tendinitis

(click here for French version)

Exercise Videos

The shoulder pain videos are based on the recommendations from the Clinical Practice Guideline for the Management of Shoulder Pain. Select a link below to view the patient exercise videos. 

 

4. Reevaluation and Discharge

  • Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.

  • Monitor for any emerging factors for delayed recovery.

5. Referrals and Collaboration

  • Refer the patient to a physician for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms​.

  • Facebook Social Icon
  • Twitter Social Icon
  • YouTube Social  Icon
  • LinkedIn Social Icon

CCGI is funded by provincial associations and regulatory boards, and national associations including the Canadian Chiropractic Association

and Canadian Chiropractic Protective Association. CCGI maintains editorial independence from funders.

OnTEchU logo_transparent.png