Shoulder pain is a common complaint, affecting nearly one in six adults annually. However, a recent study by Monash University researchers challenges the conventional approach to managing this issue. The study, published in JAMA Internal Medicine, suggests that most shoulder problems can be effectively managed through self-management, education, and time, rather than relying on unnecessary imaging and surgical interventions.
Dr. Romi Haas, a Research Fellow at the Monash School of Public Health and Preventive Medicine, led the study. She emphasizes that initial assessments should focus on ruling out serious underlying causes, such as infections, tumors, or broken bones, and distinguishing localized shoulder pain from referred pain. The traditional approach of scanning the shoulder for structural flaws is questioned, as global evidence shows that these findings are often just normal signs of aging.
Dr. Haas highlights the potential harm of unwarranted imaging, which can wrongly attribute a person's pain to age-related changes, causing undue worry, overdiagnosis, and unnecessary treatments. She argues that early scans do not improve long-term recovery and that simple supportive care, including physical examination, reassurance, and activity modifications, is often sufficient.
Subacromial pain, the most common presentation of shoulder pain, is usually felt around the top and outside of the shoulder. Dr. Haas suggests using location-based labels like 'subacromial pain' to reassure patients that it's safe to keep moving while managing symptoms. This approach helps to prevent unnecessary worry and treatments.
The study also challenges the effectiveness of common shoulder operations and corticosteroid injections. Dr. Thomas Ibounig, a shoulder and elbow surgeon, notes that high-quality evidence shows that these interventions provide no meaningful benefit over a dummy procedure. Similarly, corticosteroid injections, while providing short-term pain relief, don't routinely need to be guided by imaging.
Professor Rachelle Buchbinder, a rheumatologist and clinical epidemiologist, supports the new guidance. She notes that most people recover from shoulder pain within one year through watchful waiting or anti-inflammatory medication. The study provides a practical tool for clinicians, encouraging them to focus on self-management, time, and targeted advice as the safest and most effective path to recovery.
In summary, this research challenges the conventional approach to shoulder pain management, emphasizing the importance of self-management, education, and time. It encourages clinicians to adopt a more cautious and patient-centered approach, reducing the reliance on unnecessary imaging and surgical interventions.
