Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions.

Chronic painful shoulder is a common complaint, yet its initial pathogenesis may have multiple etiologies as well as multiple and perhaps distinct primary or secondary etiologies responsible for its final clinical presentation. While the clinical presentation of pain and limitation of motion is easily defined, there are no standardized criteria for the differential diagnosis of various chronic shoulder pain syndromes, much less a consensus on their treatment. At present, there are limited nonsurgical options and medications approved for the treatment of chronic painful shoulder, and, with limited exceptions, there are no definitive conclusions about the efficacy of these therapies based on controlled clinical studies reported in the literature. There is a clear clinical need for local nonsurgical treatments that are safe and effective for chronic painful conditions. In this article, an attempt is made to review the diagnoses associated with chronic shoulder pain and some of the limited data that exist so as to suggest a therapeutic algorithm.