Shoulder Pain Management

Synovitis

Synovitis is inflammation of the synovium (i.e., the synovial capsule), where range-of-motion is extremely painful and pain may also be experienced at rest. Synovitis may result from a variety of conditions, including glenohumeral arthritis, recent shoulder surgery or subsequent implant degradation.

Treatment Options

Initial treatment for synovitis may include anti-inflammatory medications, oral steroids or cortisone steroids injections. Corticosteroid injections should be limited to four per year, as overuse may cause cartilage and cuff degeneration. Steroid injections may be accompanied by these side effects:

• Skin blanching
• Local fat atrophy
• Infection
• Transient hyperglycemia in patients with diabetes

Key Clinical Points
• Conservative treatment with NSAIDs may help reduce symptoms of synovitis and allow the shoulder to heal.
• Physical therapy may provide relief.
• Individuals with synovitis that does not resolve with conservative treatment, including individuals with rheumatoid arthritis, may require surgical referral.

Patient Considerations

Conservative, nonoperative treatment seeks to relieve symptoms and maintain function. Patients may be advised to modify activity to avoid situations that stress the glenohumeral joint.

Know When to Refer

In some cases, surgical removal of the inflamed synovium may be recommended. In patients with rheumatoid or inflammatory arthritis who have severe synovitis but minimal articular degeneration, arthroscopic or open synovectomy may be considered.