Patients who experience shoulder pain usually are urged to follow the four-step recovery regimen known as RICE – rest, ice, compression and elevation:

In many cases, this technique will reduce pain and inflammation and the shoulder will slowly heal. Over-the-counter anti-inflammatory medications may help reduce symptoms, although these medications should not be taken without first consulting a physician.

In some cases, medical attention will be necessary to ensure that the shoulder pain is correctly diagnosed and treated appropriately.  Professional medical attention is necessary if pain lasts more than one to two weeks despite self-care measures.  Patients should also seek prompt medical care if they experience a severe blow or injury that causes pain and swelling, significant bruising or bleeding of the shoulder, especially if there is a suspected fracture, dislocation or subluxation.  

Healthcare providers will treat shoulder problems differently, depending on the nature of the problem. Treatments used for various types of shoulder problems include:

• Dislocation. A physician first treats this condition by putting the ball of the humerus (long bone of the arm extending from the shoulder to the elbow) back into the joint socket. This procedure is known as a reduction. Intravenous (I.V.) medications can be given before reduction to reduce any discomfort. The arm is then immobilized in a sling or a shoulder immobilizer for a period of weeks. Patients are often urged to apply ice to the shoulder three or four times each day.

Once pain and swelling have been controlled, the patient may enter a rehabilitation program. In some cases, a shoulder that has dislocated becomes more susceptible to the same injury in the future. Surgery may be necessary to correct this flaw.

• Separation. In most case, separations are treated by putting the arm in a sling and having the patient rest the shoulder. Within two or three months, full healing typically occurs. The patient may be required to undergo a short period of physical therapy or occupational therapy afterward. Surgery may be necessary in situations where ligaments have been severely torn.
  
  
• Tendinitis, bursitis and impingement syndrome. Rest, applications of cold treatments (cryotherapy) and anti-inflammatory medications are usually the first approaches to treating these conditions. In some cases, therapeutic ultrasound or another form of thermotherapy may be used to warm deep tissues and stimulate blood flow.

If this approach fails to relieve symptoms, the patient may be treated with an injection of a corticosteroid. In some cases, tendinitis may become chronic and can lead to the rupture of a tendon. In these extreme cases such as where treatments produce no improvement after six to 12 months, surgery may be necessary to repair the tendon.

• Torn rotator cuff. Patients are usually asked to rest the shoulder and apply cold or heat to sore areas. Anti-inflammatory medication can also help soothe these tears. Other treatments include electrical stimulation of muscles and nerves, ultrasound and corticosteroid injections. Patients sometimes will be asked to wear a sling for a few days. They are also evaluated to determine the cause of the tear and eliminate or correct the action (e.g., heavy lifting or sports movement).

In many cases, arthroscopy or other surgery may be necessary to repair severe tears. Once the rotator cuff has healed, physical or occupational therapy follows to restore range of motion of the shoulder.

• Fracture. The physician will try to bring the bone back into a position that will speed healing and restore arm movement. For a nondisplaced fracture of the clavicle (collarbone), wearing a strap or sling is usually not recommended. When the clavicle is involved, patients may be asked to wear a strap or sling around their chest. This helps keep the clavicle in place.  Fracture of the neck of the humerus is usually treated with a sling or shoulder immobilizer. Surgery may be necessary in some of these cases.

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• Frozen shoulder. Treatment usually begins with anti-inflammatory drugs and application of heat. Stretching exercises may also be part of the routine. A technique called transcutaneous electrical nerve stimulation (TENS) may be used to block nerve impulses and reduce pain. Surgery to cut adhesions may be necessary in some cases. Physical or occupational therapy may be implemented to increase the mobility of the shoulder and reduce the pain.
  
  
• Arthritis of the shoulder. This condition is treated differently, depending on the type of arthritis that is present. Osteoarthritis (which typically occurs in older people due to wearing of the joints) is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Rheumatoid arthritis may require physical or occupational therapy and additional medicines. Injection of corticosteroids into the joint can also cause temporary relief of pain.

In some cases, surgery may be necessary. For example, a worn shoulder joint can be replaced with an artificial ball for the top of the humerus and a cap on the scapula (shoulder blade). The success of joint replacement (arthroplasty) or other surgery often depends upon the condition of rotator cuff muscles before the surgery and how closely patients follow their rehabilitation regimen.

• Cervical dystonia. The U.S. Food and Drug Administration has approved injections of botulinum toxin type A (Botox) to treat this neuromuscular disorder.

Shoulder pain may sometimes indicate a more serious underlying health condition. For instance, sudden shoulder pain sometimes indicates a heart attack. Patients should seek immediate medical care if they experience sudden pressure or crushing pain in the shoulder, especially if it branches out to the chest, jaw, neck or down the arm. Medical attention is also necessary if the pain is accompanied by shortness of breath, dizziness or sweating. In cases of referred pain, treating the underlying condition would treat the shoulder pain also.