Shoulder Pain and Injuries

Learn more: watch the video or read the transcript below.

The Structure of the Shoulder

The shoulder is a complicated joint. It moves in many directions, and it can be very stubborn when it starts to become painful. The first thing a person wonders when they experience shoulder pain is “What’s going on with my shoulder?” Since the term rotator cuff is so common, many patients come in to my office and ask if they might have a rotator cuff tear.

First let’s talk about the structure of the shoulder which is one of the most movable joints in the body, but not the most stable. The way the shoulder is structured, you will see that it is basically a ball-and-socket joint. The ball-and-socket joint sits beneath a bony ceiling that is made up by the clavicle and the acromion, which is a bony projection at the outer edge of the shoulder blade. When you reach and touch your shoulder, you will feel that bony ceiling. Between the bony ceiling and the top of the ball-and-socket joint is a very complex and dynamic environment. Contained in this area is a group of tendons, blood vessels, and other structures, which include fatty tissue and bursa.

The bones of the shoulder are held in place by tendons, muscles and ligaments.  The five tendons of the rotator cuff, which hold the bones of the shoulder in place, begin as muscles that come up and insert into the ball part of the ball-and-socket joint. Those muscles and tendons provide us with all of the fine motor movements of the shoulder.

Tightness of the Shoulder

Many of my patients with shoulder pain come to see me because they are experiencing a limited range of motion, pain that occurs with everyday activities, and pain while sleeping. This can be caused by a person creating an impingement, or pinching, in their shoulder just by tensing the shoulder during activities. The repeated tensing of the shoulder can begin to shorten and tighten the musculature that houses the shoulder, and it can create a condition called Impingement Syndrome. This is when the tendons can be trapped under the acromion, and the ball-and-socket joint is pulled and starts to rub and grind away at the tendons.

Tendon Problems of the Shoulder: Descriptions and Symptoms

  • Tendonitis
    • This is simply inflammation of the tendon. This not only occurs in baseball pitchers who constantly use their shoulder, but can be a result of injury or simply from aging.
  • Tendinopathy
  • This when we start getting tearing of the tendons themselves. The tears come in four grades:
    • Grade one is an inflammation or some very, very fine tearing of some of the fibers in the tendon.
    • Grade two has a little bit more damage to the tendon, and it’s starting to get some depth to the tear itself. The person is probably already starting to have some problems sustaining weight with that shoulder motion.
    • Grade three is when the tendon has a fairly deep tear to it, and the person is probably going to have some real difficulty taking the shoulder through ranges of motion.
    • Grade four is where the tendon is torn completely in two.

Diagnosis and Treatment

The first step in dealing with shoulder pain, as with any large joint, is getting a correct diagnosis. A determination needs to be made as to whether it is a muscular issue; a tendonitis, an inflammation of one or more of the five tendons of the shoulder; a tendinopathy with tearing or a combination of issues.

That’s where the diagnostic process comes in. In our office we perform testing to make a determination about which category a patient’s pain or injury is in.

When a patient is in the early stages of these conditions, our treatments includes rest, ice, massage therapy, physiotherapy in the office, and perhaps manipulation of the neck or the shoulder. We will usually carry out about a two-week course of care as long as we see improvement and we are convinced that we are helping. If there is no improvement, we will provide you with a timely referral. We have referred patients for physical therapy, massage-therapy, and if needed, for an MRI and then on to the orthopedic surgeon for a consultation.

If you would like further information on shoulder pain or problems, please go to our website,  To make an appointment to be examined at our office, please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.