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Current Non-operative Management of Shoulder Pathologies: A Narrative Review.

Ricardo A Vargas-Figueroa1,2, Derick Rodríguez-Reyes1, Hiram E Luigi Martinez1

  • 1Department of Orthopaedic Surgery, Ponce Health Sciences University, Ponce, PRI.

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Non-operative treatments are key for common shoulder disorders like rotator cuff pain and osteoarthritis. Exercise rehabilitation offers significant pain relief and functional improvement, often comparable to surgery.

Keywords:
acromioclavicular jointbiceps tendinopathyglenohumeral osteoarthritisidiopathic adhesive capsulitisphysical therapy modalitiesrotator cuff pathologyrotator cuff tearsselective non-operative managementshoulder instabilityslap tear

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Area of Science:

  • Orthopedics and Sports Medicine
  • Rehabilitation Science
  • Evidence-Based Medicine

Background:

  • Shoulder disorders are common, causing pain and disability.
  • Non-operative management is the primary approach, with surgery reserved for severe cases.
  • This review focuses on evidence-based non-operative strategies for prevalent shoulder pathologies.

Purpose of the Study:

  • To systematically review current non-operative management strategies for common adult shoulder pathologies.
  • To synthesize evidence on the efficacy of various conservative treatments.
  • To provide an overview of best practices in non-operative shoulder care.

Main Methods:

  • Systematized narrative review of literature from 2010 to October 2025.
  • Searches included MEDLINE, Cochrane Library, and major guideline repositories.
  • Prioritized clinical guidelines, systematic reviews, and randomized trials, synthesizing findings qualitatively.

Main Results:

  • Exercise-based rehabilitation is foundational, improving pain and function across conditions.
  • For subacromial pain, exercise outcomes rival surgical results.
  • Specific interventions like corticosteroid injections, hydrodilatation, and nerve blocks offer short-term relief for adhesive capsulitis when combined with mobilization.

Conclusions:

  • Exercise is the cornerstone of non-operative shoulder management.
  • Targeted non-operative interventions can effectively manage various shoulder conditions, including osteoarthritis and instability.
  • Conservative care provides significant benefits, often delaying or avoiding the need for surgery.