Everything you need to know about pain and how we can help you

The importance of the soft tissues relating to chronic pain is poorly understood. A person experiencing shoulder pain but who has not had a traumatic injury does not need surgery. This pain, originating in muscle and connective tissue, is very easily corrected, and even chronic problems such as rotator cuff tears almost NEVER require surgery.

The shoulder is very complex. Its design gives the shoulder joint great range of motion, but to achieve that it sacrifices stability. The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). Tendons attach muscles to bones. Muscles move the bones by pulling on the tendons.

The rotator cuff connects the humerus to the scapula and holds it in its socket. The tendons of four muscles form a covering around the head of the humerus called the rotator cuff: the supraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff helps raise and rotate the arm. As long as all the parts are in good working order, the shoulder can move freely and painlessly.


  • Pain at rest and at night, especially while lying on the affected shoulder
  • Pain with specific movements
  • Weakness when lifting or rotating the arm
  • Crepitus (clicking or popping sensation) when moving the shoulder

Typically, a person with a rotator cuff injury feels pain over the deltoid muscle at the top and outer side of the shoulder, especially when the arm is raised or extended outward. Getting dressed or combing hair may become painful and difficult. The shoulder may feel weak, especially when trying to lift the arm horizontally.


Several factors are thought to contribute to degenerative, or chronic, rotator cuff tears.

  • Repetitive stress. Repeating the same shoulder motions again and again can stress the rotator cuff muscles and tendons. Baseball, tennis, rowing, and weightlifting are examples of sports activities that can put one at risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well.
  • Impingement of the front of the scapula, the acromion, on the tendon is believed to be a major cause.
  • Injury.


Nonsurgical treatment relieves pain and improves function in the shoulder about half the time, but such treatments do not usually improve shoulder strength without surgery.

Nonsurgical treatment options may include:

  • Rest. Doctors may suggest rest and and limiting overhead activities, and may also prescribe a sling to protect and immobilize the shoulder.
  • Non-steroidal anti-inflammatory medication such as ibuprofen and naproxen.
  • Strengthening exercises and physical therapy such as electrical stimulation and ultrasound.
  • Steroid injection. Usually of a local anesthetic and cortisone near the inflamed area.

Surgery is recommended for many:

  • Most commonly, the tendon is “reattached” to the bone.
  • If impingement is considered to be the problem, the tip of the acromion bone might be removed or extra bone growth might be shaved off.


Muscle and connective tissue, which is almost always the core of the problem, is very easily treated, with complete recovery. The problem almost always is resolved by attending to adhesions that might be present from injury or inflammation and trigger points in the muscles involved.

  • Reattachment surgery is necessary ONLY if there is a COMPLETE detachment of the tendon, which is almost never the case. “Torn” tendons are generally frayed tendons that fray slowly over time. Pain can often be eliminated by releasing tension in the attached muscle, thus relieving the pulling or tension on the attachments.
  • Impingement can often be caused by tight pectoral muscles that shift the position of the humerus within the joint. In that case, simply releasing the muscle corrects the problem completely.

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