Pain in the Shoulder


Pain in the shoulder is a relatively common ailment. It can be frustrating, limiting mobility and interfering with activities. Many factors can contribute to shoulder pain and there are a number of treatments to help manage it.

Understanding and Appreciating the Shoulder

The shoulder is a critical, underappreciated joint. The hands and feet, as well as parts of the face, get a lot of applause, but imagine the limits we would be subject to if our shoulders were dysfunctional. Without the shoulder, you could not reach, throw, play, scratch, hug or lift many objects.

The shoulder has a humerus. The humerus, the long upper arm bone, is anchored to a shallow, small surface on the scapula by its spherical head. This connecting musculature allows the body to move the entire arm and hand across the body in varying directions. The movement allows reaching away from the body, being instrumental in almost everything we do with our hands.

The shoulder is held in place by ligaments, muscle and a labrum. The labrum is cartilage that adds stability to the shoulder joint. A small area, the labrum functions as a blocker, preventing risky movement. Shoulder ligaments and muscle are grouped together as the rotator cuff. It consists of a network of parts – supraspinatus, infraspinatus, subscapularis, teres minor – that manage the flexibility and strength of the shoulder. The rotator cuff keeps the humeral head in place as the shoulder rotates in space.

What Other Factors Impact Shoulder Mobility?

Though the major components are aforementioned, the overall health of the shoulder is dependent on about 20 primary muscles called the shoulder girdle. These include the clavicle, scapula, ribs, thoracic spine, cervical spine and even the elbow. Disruption in any of these muscles can lead to weakened mobility and pain in the shoulder. A good example would be a strain in the thoracic spine while harmlessly reaching at a top shelf. If done wrong, the action can complicate the shoulder’s end range reach. Stiffness of the upper thorax may restrict shoulder movement.

Recognizing Pain in the Shoulder

Pain in the shoulder can result from any of the following:

•Strain or sprain from overexertion
•Instability in the shoulder joints
•Tendinitis as a result of overuse
•Thoracic outlet syndrome (compression in the first rib and collar bone)
•Torn cartilage
•Septic and rheumatoid arthritis
•Bone fracture in the upper arm or collar bone
•Separated shoulder
•Frozen shoulder (stiffness or limited range of motion)
•Radiculopathy (pinched nerve)
Rotator cuff injury
•Shoulder Bursitis

What Could Go Wrong?

Considering the intricacy of the shoulder joint, it comes as no surprise that should something go wrong there would be a major impact on the body’s functionality. Shoulder dysfunction can come from dislocations, fractures, ligament tears, rotator cuff tear or tendinitis. These can result in simple aches, or debilitating pains that can make lifting the arm difficult.

We are all at risk of shoulder pain, not even realizing we’ve strained or traumatized the area until it hurts for what we believe to be for no specific reason.

Physical Therapy

A lot of pain in the shoulder will go away on its own as the body repairs itself. But if you have a consistent pain or one that is periodic, you should consult with a doctor as soon as possible. If you have developed shoulder pain through a traumatic incident, such as a fall or car accident, you have to seek out medical attention right away. Should you find you have lost significant function in the shoulder or tasks are becoming difficult, you should schedule a visit with your doctor, a physical therapist or other trained healthcare professional familiar with this condition.

Treatment will be dependent on the type and severity of the injury. A goniometer may be utilized to measure the strength of the shoulder and range of motion. Tests may be administered to determine what structure could be responsible for the pain.

After assessment, rest or exercise may be suggested. Physical therapy for shoulder pain may be required. Whatever the treatment, there should be a noticeable improvement over the following weeks.

Physical therapy will be instrumental in determining the exact cause of pain, allowing avoidance of future problems.


Our shoulders are critical to mobility and natural function. Without it, we lack stability. Unfortunately, the vast mobility of the shoulder also leaves it susceptible to a range of injuries and resultant pain. By keeping our shoulders strong and mobile, and getting physical therapy for shoulder pain, we minimize risks.

If you are having pain in the shoulder, arrange a consultation and exam with a professional right away. You can reduce the likelihood of persistent pain and of it returning.


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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