Medication Summary
Anti-inflammatory medications are the mainstays of medical therapy for swimmer's shoulder. These agents are used to help decrease inflammation of the rotator cuff, and in doing so, help relieve pain, prevent further damage, and speed recovery.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Class Summary
Agents are mostly oral, systemic medications (except for Toradol), which are used to decrease inflammation without the side effects of corticosteroids. COX-2 inhibitors may decrease the risk of GI toxicity and bleeding problems due to platelet inhibition caused by older NSAIDs.
Ibuprofen (Advil, Excedrin IB, Motrin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Celecoxib (Celebrex)
Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.
Corticosteroids
Class Summary
Either oral or injectable are perhaps more potent than NSAIDs, they can last longer, but have more side effects and are seldom used in teenage athletes, unless there is a pressing, agreed upon reason for exposing the athlete to the somewhat higher risk of side-effects and complications arising from their use.
Methylprednisolone (Medrol Dose Pack)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Triamcinolone (Kenalog)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.
