Management of persistent shoulder pain: a treatment algorithm

Treatment of patients with complex multifactorial diseases can be clarified by the development of clear, evidence-based treatment guidelines or algorithms. This article presents a detailed algorithm for the management of patients who present with persistent shoulder pain secondary to rotator cuff disorder, adhesive capsulitis, or glenohumeral osteoarthritis. The algorithm includes both nonpharmacologic and pharmacologic interventions and provides a stepwise approach for managing patients' care. While "treatment pathways" are set forth for these specific disorders, the algorithm also provides a common nonoperative protocol for general shoulder conditions that should help simplify patient management and guide clinicians to alternative therapies.