Shoulder pain is one of the most common musculoskeletal complaints accounting for at least 4.5 million patient visits annually in the United States and occurring in as many as 51% of individuals in a lifetime. Moreover, the economic burden of shoulder pathology is vast with annual direct costs for treatment of shoulder dysfunction totaling at least $7 billion in the United States, mostly due to operative treatment. In Germany the percentage of affected patients and associated costs are expected to be similar. Moreover, with an aging and increasingly active patient population in the Western world, the absolute number of shoulder pathologies is likely to grow, further increasing costs.

These economic implications highlight the critical need for appropriate diagnosis and treatment of various shoulder pathologies, as under-diagnosis and under-treatment can result in increased costs to society with disability and lost production. On the other hand, aggressive over-treatment can further inflate already burgeoning health-care costs and potentially harm the patient.

Therefore, the purpose of this review is to distinguish the indications between operative and nonoperative management for five common shoulder pathologies, including rotator cuff tears, anterior shoulder instability, biceps tendinitis, lesions to the acromioclavicular (AC) joint, and proximal humeral fractures. Moreover, we aim to provide a short overview of the nonoperative management of each of these pathologies.

Full Article: Nonoperative treatment of five common shoulder injuries