Nonpharmaceutical Modalities for Shoulder Pain and ROM (Pt. 1)

Nerve blocks and surgery have been used to treat shoulder pain after surgery and pain associated with shoulder impingement, with conflicting evidence. Suprascapular nerve block has been evaluated in patients with postoperative shoulder pain following a thoracotomy. In 2002, Tan, et al., conducted a double-blind, placebo-controlled, randomized controlled trial of 30 patients with postoperative shoulder pain. This study showed that suprascapular nerve block does not relieve the severe ipsilateral shoulder pain patients experience after thoracotomy.¹

In 2016, Chang, et al., carried out a systematic review and meta-analysis of seven randomized, controlled trials involving more than 600 patients. Patients undergoing laparoscopic surgery or thoracotomy did not experience reduced postoperative shoulder pain following suprascapular nerve blockade.²

Surgery also has been examined in patients with shoulder pain due to impingement. In 2019, Khan, et al., performed a meta-analysis and systematic review of 13 randomized, controlled trials including more than 1,000 patients. The analysis indicates that there is no demonstrated benefit from surgical intervention in reducing shoulder impingement pain.³

Spinal Manipulation

Patients with and without musculoskeletal shoulder symptoms have reported improvements in range of motion, pain and disability following high-velocity, low-amplitude, thoracic manipulation therapy directed at the thoracic spine and ribs. In 2011, Brantingham, et al., performed a systematic review of 35 articles; combined with multimodal or exercise therapy for rotator-cuff injuries / disorders / diseases, this study found level B or fair evidence for manual and manipulative therapy of the  shoulder, shoulder girdle and/or the full kinetic chain.

For problems with shoulders, dysfunction, disorders, and/or pain, a multimodal treatment approach combined with manual and manipulative therapy of the shoulder girdle and full kinetic chain was an acceptable or B level of  evidence.⁴

In 2015, Riley, et al., published a randomized, controlled trial of 100 consecutive shoulder pain patients. The majority of time points assessed showed statistically significant differences between groups, and interventions had a positive effect on patients.⁵

Kinesiology Tape

Kinesiology tape has been used by athletes and patients around the world for shoulder range of motion and other areas of the body. In 2008, Thelen, et al., designed a prospective, randomized, double-blind clinical trial of 42 subjects. In this study, it was shown that kinesiology tape could contribute to the improvement of pain-free active range of motion following application of the tape to patients with shoulder pain.⁶

In 2020, Deng, et al., published a systematic review and meta-analysis of nine randomized, controlled trials totaling over 400 patients. After kinesiology taping treatment, shoulder pain patients with hemiplegic shoulder pain experienced improved motor function and the ability to perform daily activities.⁷

Low-Level Laser Therapy

Low-level laser is typically used as adjunct therapy to improve shoulder range of motion. In 2011, Abrasham, et al., conducted a placebo-controlled, double-blind, randomized, controlled trial of 80 patients. The researchers concluded that low-level laser therapy and exercise provide better pain relief for patients with symptoms of subacromial syndrome and improved shoulder range of motion than exercise therapy alone.⁸

In 2017, Hawk, et al., carried out a systematic review of 25 systematic reviews and 44 randomized, controlled trials. Several shoulder conditions, including nonspecific shoulder pain, were supported by moderate evidence, with low-level laser treatments as the only modality.⁹

Editor's Note: Part 2 of this article (August digital issue) discusses the research support for additional modalities including massage, acupuncture and nutritional supplementation.

References

1. Tan N, Agnew NM, Scawn ND, et al. Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and 0.9% saline. Anesth Analg, 2002;94(1):199-202.
2. Chang K-V, Wu W-T, Hung C-Y, et al. Comparative effectiveness of suprascapular nerve block in the relief of acute post-operative shoulder pain: a systematic review and meta-analysis. Pain Physician, 2016;19(7):445-456
3. Khan M, Alolabi B, Horner N, et al. Surgery for shoulder impingement: a systematic review and meta-analysis of controlled clinical trials. CMAJ Open, 2019;7(1):E149-E158.
4. Brantingham JW, Cassa TK, Bonnefin D, et al. Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manip Physiol Ther, 2011;34(5):314-346.
5. Riley SP, Cote MP, Leger RR, et al. Short-term effects of thoracic spinal manipulations and message conveyed by clinicians to patients with musculoskeletal shoulder symptoms: a randomized clinical trial. J Man Manip Ther, 2015;23(1):3-11.
6. Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther, 2008;38(7):389-395.
7. Deng P, Zhao Z, Zhang S, et al. Effect of kinesio taping on hemiplegic shoulder pain: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2021;35(3):317-331.
8. Abrisham SMJ, Kermani-Alghoraishi M, Ghahramani R, et al. Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial. Clin Rheumatol, 2011;30(10):1341-1346.
9. Hawk C, Minkalis AL, Khorsan R, et al. Systematic review of nondrug, nonsurgical treatment of shoulder conditions. J Manip Physiol Ther, 2017;40(5):293-319.