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Shoulder pain - Management
Basis for recommendation

Approach to management

  • Unless a traumatic dislocation is suspected, symptoms of acromioclavicular joint problems usually resolve with rest and simple analgesia [Mitchell, 2008].

Rest

  • A New Zealand guideline on the diagnosis and management of soft tissue shoulder injuries and related disorders [NZGG, 2004], a review of the management of shoulder disorders in primary care [Mitchell, 2008], and a review of the management of chronic shoulder pain [Burbank et al, 2008] recommend rest and activity modification for acromioclavicular joint disorders.
  • A New Zealand guideline recommends the use of a sling for 5–7 days to treat acromioclavicular sprains [NZGG, 2004].

Analgesia

  • CKS found no evidence on the use of paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or codeine for the treatment of shoulder pain caused by acromioclavicular joint disorders, therefore the decision should be based on clinical judgement, taking into account the severity of the person's symptoms and comorbidities.
    • For more information on the adverse effect profile and contraindications to prescribing NSAIDs, see the CKS topic on NSAIDs - prescribing issues.
  • CKS has not recommended the use of stronger opioids in primary care as they are generally reserved for people with moderate-to-severe pain and long-term treatment should be undertaken with caution because of the potential for dependence [Iannotti and Kwon, 2005; Moskowitz and Blaine, 2005].

Physiotherapy

  • CKS found no evidence to support the use of physiotherapy in people with acromioclavicular joint disorders.
  • A New Zealand guideline mentioned that various methods of taping are used in the early management of acromioclavicular joint sprains, but there is no evidence to support this. This guideline also recommended a trial of rehabilitation after 4–6 weeks if there has been a poor response to rest and analgesia [NZGG, 2004].

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