Getting to the Source of Shoulder Pain


The shoulder is a highly mobile joint, able to move in multiple planes due to its versatile ball-and-socket structure. But the tradeoff for mobility is complexity, with multiple nerves, muscles, ligaments and tendons surrounding the joint to stabilize it and produce movement. When shoulder pain sets in, it is important to work with a specialist who understands shoulder anatomy and biomechanics, who can pinpoint the exact source of pain.

Common Causes of Shoulder Pain

Shoulder pain is fairly common among physically active people, especially athletes who engage in sports that involve throwing or overhead movements. Baseball, tennis, golf, swimming, volleyball, lacrosse and many other sports can lead to overuse injuries of the shoulder. However, shoulder pain can also be occupational, or it can simply occur from lack of physical activity and aging.

Common causes of shoulder pain include:

  • Rotator cuff tears
  • Shoulder joint instability
  • Arthritis or bursitis
  • Nerve impingement in the neck or shoulder
  • Bone spurs
  • Fracture

In addition to structural sources of pain, shoulder pain can originate from stimulus of the central nervous system through various neurological pathways. In some patients, central sensitization takes place, where the patient experiences a heightened sense of pain in the absence of, or out of proportion to, injury or pathology.


Shoulder Pain Diagnosis

Shoulder pain diagnosis includes a clinical exam that begins with a medical history of the pain onset and associated activities. The exam will include assessments for strength and range of motion, along with imaging by Xray, MRI or ultrasound to get a thorough picture of any structural abnormalities.

Shoulder Pain Treatment

In the vast majority of cases, shoulder pain can be completely resolved with conservative care, without surgery.

Common treatment approaches include:

  • Change or rest from activities that cause pain
  • Anti-inflammatory medications
  • Physical therapy exercises to restore strength, stability and range of motion

Shoulder Pain Treatment in NYC

At NYDNR, we take a holistic approach to treating shoulder pain, considering each patient on a case-by-case basis. In addition to traditional physical therapy, we use advanced technologies and innovative therapies to restore function and eliminate pain.

Our treatments for shoulder pain may include:

  • ESWT (extracorporeal shock wave therapy)
  • Trigger point release techniques
  • Ultrasound guided needling therapies
  • DNS (dynamic neuromuscular stabilization)
  • Brain retraining therapy to treat central sensitization

Don’t let shoulder pain keep you from enjoying the activities you love. Contact NYDNR today, and get back to your busy active lifestyle.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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