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Acute shoulder injuries

Definition and prevalence

Acute shoulder injuries include sprains and strains, rotator cuff pathologies, impingement syndrome, frozen shoulder, instability disorders (acute and recurrent dislocation and other types of instability), bruises and contusions.

Acute shoulder pain is pain felt in the shoulder region that lasts for up to six weeks. Around 10% of people will experience an acute shoulder injury at some stage in their lives. Guidelines for shoulder pain identify different physical examination requirements and X-ray positions to assist assessment and diagnosis of the above mentioned conditions.

Guideline recommendations

Assessment

  • The initial assessment should aim to identify serious underlying pathology (red flags) and other clinically significant structural damage [1]. Significant structural damage requires an urgent referral to a medical specialist [1].
  • Screen for extrinsic causes of shoulder pain (including cervical spine disorders, nerve disorders, inflammatory disorders, and visceral referred pain) [1].
  • Screen for psychosocial and occupational risk factors (yellow flags) risk factors (yellow flags) such as job dissatisfaction and work demands, which may contribute to the onset of acute shoulder pain [2]. Explicit screening for yellow flags should be undertaken where no improvement has occurred four to six weeks following the injury.
  • Imaging is not necessary unless there are features of serious underlying pathology. Imaging should be undertaken where there is suspicion of fracture, dislocation, or where surgery is being considered as a management option [1].

Treatment

  • Mild to moderately strong analgesia may be useful, depending on the type of shoulder injury [1].
  • Supervised exercises programs in conjunction with medical management may improve shoulder pain and function for patients with rotator cuff pathologies in both the short and longer-term [1].
  • Following dislocation, people should not return to sport for at least six weeks [1].
  • An outcome measure or screening tool (eg, the Shoulder Pain and Disability Index) should be used to evaluate treatment effectiveness.

Best practice and emerging evidence

  • Shoulder joint mobilisation with combined treatments (hot packs, active exercise, stretching, soft tissue mobilisation and education) may improve acute shoulder pain in the short term [2].
  • If there is clinical evidence of impingement which has not improved after four weeks of appropriate conservative treatment, then subacromial corticosteroid injection should be considered. This may need to be repeated because the benefit is generally not maintained at 12 weeks [2].
  • Therapeutic ultrasound may provide short-term pain relief in calcific tendonitis [2].

References

  1. Accident Compensation Corporation. The Diagnosis and Management of soft tissue shoulder injuries and related disorders - Best practice evidence-based guideline. July 2004.
  2. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain. Bowen Hills: Australian Academic Press; 2003.

 

Expected recovery timeframes

Where an individual has not recovered within the expected recovery timeframe, the diagnosis and management plan should be reconsidered. Reassess for serious underlying pathology (red flags), undertake screening for psychosocial risk factors (yellow flags), and reconsider treatment type and intensity.

Expected recovery timeframes for shoulder injuries can be found below.

Sprain/strain
Expected healing time: 6 weeks
Notes: Most non-specific strain/sprain injuries should heal within 6 weeks.

Rotator cuff tendinopathy
Expected healing time: 2-12 weeks
Notes: Rotator cuff tendinopathy without impingement should resolve with removal of the causative activity and restricting shoulder movement to the pain free range in the acute (first 6 weeks) phase.

Impingement syndrome
Expected healing time: 2-12 weeks<
Notes: Removal of any causative activity will assist healing. Conservative treatment may be unsuccessful.
There will generally be a pain-free range of shoulder movement and the ability to continue activity within that range of movement.

Dislocation
Expected healing time: 3-12 weeks
Notes: Healing depends on whether it is the acromioclavicular or glenohumeral joint which is dislocated, the amount of associated injury and if surgical intervention is required. In most instances healing should occur within 6 weeks.

Bruises/contusions
Expected healing time: 2 weeks
Notes: If there is significant associated tissue injury, particularly with a crush injury, healing may be slower.

Fact sheets for injured workers

The provision of information and education about the injury is an important intervention, which can promote effective self management of symptoms. A number of fact sheets are available to provide to an injured worker. Examples include:

WorkCoverSA Caring for your shoulder pain

National Health and Medical Research Council Acute Shoulder Pain information sheet

Links to clinical guidelines