An overview of treatment options for persistent shoulder pain.

Persistent shoulder pain (PSP) associated with rotator cuff disorders, glenohumeral osteoarthritis (OA), or adhesive capsulitis is a very common, often difficult-to-treat condition. The first step in nonoperative therapy for PSP in most patients is physical therapy, rest, and use of various heat modalities. Relief of pain from exercises aimed at improving strength and range of motion may be enhanced by administration of oral analgesics. Oral nonsteroidal anti-inflammatory drugs are often prescribed for patients with PSP, but their use may be complicated by gastrointestinal side effects and a potential for increased risk for serious cardiovascular events. Intra-articular corticosteroid injections have been demonstrated to provide benefit in patients with rotator cuff disorders and perhaps also in those with adhesive capsulitis. Results from both small-scale studies and a recent large-scale trial have shown that injection of sodium hyaluronate is also effective for the treatment of PSP, particularly in patients with glenohumeral OA. Additional well-controlled comparative trials are needed to define which treatment modalities are likely to be most effective in subsets of patients with PSP.