Shoulder pain is both common and widespread. It affects up to 67% of adults and can be caused by a variety of conditions. Such conditions include: subacromial impingement (shoulder pain syndrome, rotator cuff tendinopathy/tears, and adhesive capsulitis (frozen shoulder).

The specific treatment used will vary based on the diagnosis and the severity of the condition. Below, we breakdown multiple effective, evidence-based options and where in Anchorage, Alaska you can receive them.

I. Most Common Shoulder Conditions & Optimal Treatments

1. Subacromial Pain Syndrome (Shoulder Impingement)

Subacromial pain syndrome, or shoulder impingement, is a common condition that is caused by compressing or otherwise irritating the structures in the subacromial space of the shoulder. Typical structures include the rotator cuff and/or bursa.

Physical therapy and manual therapy are the preferred treatment options for this condition because they are effective over the long term. Corticosteroid injections are another option, at least for the short term.

In fact, a study on PubMed found that corticosteroid injections were slightly better over the first 6-7 weeks, but roughly the same at the 6 month and 1 year marks.¹ 

This does suggest that patients suffering from subacromial pain syndrome might start treatment with a course of physical therapy and manual therapy. From there, they could add a short course of corticosteroid injections if rapid relief is needed.

Providers for these types of treatment include physical therapists, chiropractors, and orthopedic/spine specialists.

2. Rotator Cuff Tendinopathy / Tears

The rotator cuff is a group of tendons and muscles found in the shoulder. If a tendon there is damaged or tears, it can cause great pain. This condition is called rotator cuff tendinopathy or a rotator cuff tear.

The best treatment plans usually use exercise therapy and manual therapy. Another possibility is platelet-rich-plasma (PRP) injections which have shown early promise. Surgery is another option that is reserved only for significant tears.

Treatment recommendations often suggest the patient starts with active therapy combined with manual interventions. If the condition persists, PRP injections can be used. The last option in severe cases is surgery.

Providers for these types of care include physical therapists, chiropractors, regenerative medicine centers, and orthopedic surgeons. 

3. Adhesive Capsulitis (Frozen Shoulder)

Another type of shoulder injury is adhesive capsulitis or frozen shoulder. This is a condition where the shoulder becomes stiff and painful. Also, because the shoulder joint capsule becomes inflamed and thickens, range of motion is significantly hampered.

A top treatment option for a frozen shoulder is physical therapy combined with intra-articular corticosteroids. Other multimodal approaches – like manual therapy combined with injections – also have added benefits.

Recommendations for a frozen shoulder typically start with the corticosteroid injections plus PT and/or manual therapy early on. Other more invasive procedures should only be used if the condition persists for a long time.

Medical care professionals who treat this condition include physical therapists and pain specialists (for injections) often under the oversight of an orthopedic specialist or a shoulder specialist. 

II. Treatment Categories

A. Conservative Management – Physical Therapy & Chiropractic Care

Most patients dealing with shoulder pain usually begin with conservative types of care. The most common of such are physical therapy and chiropractic care. PTs and chiropractors have a number of tools at their disposal to help with shoulder pain.

They often prescribe multiple treatments like therapeutic exercise, manual therapy, and a combination of joint and soft-tissue mobilizations. In fact, these conservative measures are often beneficial to all three types of shoulder injury noted above.²

You can find these types of caregivers at physical therapy clinics or chiropractic offices with chiropractors skilled in shoulder biomechanics and manual techniques. In Anchorage, AK such places include:

• Better Health Alaska
• Alaska Fracture and Orthopedic Clinic

B. Injection-Based Interventions

Another type of treatment for shoulder pain are the injection-based interventions like corticosteroid and platelet-rich plasma (PRP) injections.

1. Corticosteroid Injections

Corticosteroid injections are best for short-term relief in impingement cases and adhesive capsulitis. As detailed in the PubMed study noted above, corticosteroids provide faster relief than physical therapy out to a time of six weeks. However, there is no advantage over longer periods of time.

Providers of corticosteroid injections include: orthopedic and sports medicine clinics, as well as pain specialists. In Anchorage, AK, you can find such providers at the following locations:

• Advanced Pain Center Alaska
• Alaska Center for Pain Relief, Inc.
• Urban Pain Institute

2. Platelet-Rich Plasma (PRP)

Platelet-rich plasma is a therapy that harnesses the healing power of the patient’s own platelets. It uses a centrifuge to separate the platelets and plasma out from the other components of the patient’s blood and injecting the result mix into the site of the injury. 

It is best for partial rotator cuff tears and chronic tendinopathy. One study on Science Direct, for example, found it to be superior to corticosteroids on pain and function out to 3 – 6 months.³

Access to PRP injections can be found at regenerative medicine or sports medicine centers. In Anchorage, PRP therapy is located at the following medical offices and centers:

• Better Health Alaska
• Arctic Medical Center
• Alaska Fracture & Orthopedic Clinic

III. Advanced & Surgical Options

A. Arthroscopy (Rotator Cuff Repair, Decompression)

Arthroscopy is an operation that makes a small incision near the joint (in this case, the shoulder) and then insert an arthroscope with a small camera and light attached. From there, the condition of the shoulder can be assessed and repairs of the damaged tissue can be made. 

It is sometimes used in conjunction with decompression, a procedure in which bone and/or tissue that is impinging on the rotator cuff is removed to create more space and alleviate pressure on the rotator cuff.

It is best for significant tears of the rotator cuff or in situations where significant symptoms still persist after attempts at conservative therapy have failed. And it is usually reserved for the largest and most traumatic of tears.

Arthroscopy is usually only performed by orthopedic shoulder surgeons.

• Alaska Spine Center
• Orthopedic Physicians Alaska
• Alaska Fracture and Orthopedic Clinic

B. Capsular Release (Frozen Shoulder)

Capsular release is a type of surgery used on adhesive capsulitis or frozen shoulder. It involves a type of arthroscopic surgery (small incision, camera, light) that is used to reduce pain and improve range of motion in the shoulder. It is best used in severe cases that have proven resistant to other treatment modalities over a period of 6 to 12 months.

Patients seeking this kind of treatment should look to orthopedic surgery centers that specialize in shoulder procedures. In Anchorage, AK, this includes the following locations: 

• Alaska Shoulder & Orthopedic Institute
• Schumacher Orthopedics
• Alaska Fracture & Orthopedic Clinic

IV. Where to Seek Care

Conclusion

Ultimately, patients seeking shoulder pain relief should understand several important points. First, shoulder pain treatments should be condition-specific, and PT and manual therapy (i.e. conservative care) should be the options of first resort. Second, although corticosteroid injections offer rapid relief in some cases, they are best used when combined with other therapies that provide longer lasting rehabilitation.

Third, PRP injections, a recent technological development, show significant promise for healing tendons – especially in the rotator cuff. Additionally, chiropractic care, through the use of targeted manual therapy, enhances biomechanics and complements other types of rehabilitation. Next, surgery should be a last resort option that is only used for specific structural issues or after the usual conservative efforts have failed.

Finally, every treatment plan should begin with consulting a qualified healthcare professional – physical therapists, chiropractors, orthopedists, or pain specialists – to point you in the right direction and get you on the path to health.

Here at Better Health Alaska, we have a number of healthcare professions under one roof – physical therapists, chiropractors, and more. So, if you are dealing with shoulder pain, reach out and set up an appointment. Our team can develop a treatment plan tailored to your specific needs and get you back on the road to better health.  

Sources and Studies

1. Burger, M., et al., “Effect of corticosteroid injections versus physiotherapy on pain, shoulder range of motion and shoulder function in patients with subacromial impingement syndrome: A systematic review and meta-analysis,” Pub Med: South African Journal of Physiotherapy, 2016 Sep 27;72(1):318. https://pubmed.ncbi.nlm.nih.gov/30135893/ 
2. Ibid. https://pubmed.ncbi.nlm.nih.gov/30135893/ 
3. Pretorius, J., et al., “The efficacy of platelet-rich plasma injections compared to corticosteroids and physiotherapy in adhesive capsulitis: A systematic review and meta-analysis,” The Journal of Orthopaedics, Vol. 47, Jan. 2024, pgs. (35-44), https://www.sciencedirect.com/science/article/abs/pii/S0972978X23002477