Your shoulder is a complex ball-and-socket joint, capable of movement in multiple directions. The shoulder’s unique range of motion enables you to perform a broad variety of actions and tasks, but its mobility also makes it the most unstable joint in the human body. Because of the complex network of structures involved in shoulder movement, pain can stem from multiple causes.
Shoulder pain can be sharp, deep, achy or widespread, depending on the structures involved. Shoulder pain is typically worse when the arm and shoulder joint are in motion. Specific movements may elicit pain that reveals the underlying cause.
Shoulder muscle pain in the deltoid is typically the result of exercise or an isolated incidence of overuse, and usually resolves itself in a matter of days.
Chronic shoulder pain is more likely to stem from tendonitis or ruptures of the rotator cuff, a group of muscles and tendons that maintain joint integrity and make it possible for you to raise and rotate your arm.
Other common causes of shoulder pain include:
A health history and physical exam are often sufficient to diagnose shoulder pain.
The use of real-time diagnostic ultrasound enables us to view the structures of the shoulder in motion, to screen for rotator cuff tears, bursitis, tendon tears, joint inflammation and arthritis.
Once diagnosis is confirmed, we can then proceed with an appropriate individualized treatment plan.
Dr. Kalika uses highest resolution ultrasound machine in NY with resolution capabilities exceding MRI. You wouldn’t need to be referred out for imaging , it will be done on the spot.
At NYDNR, we use a combination of non-invasive treatment methods, aimed at reducing pain and improving mobility.
Physical Therapy Treatment: Exercises designed to strengthen and stretch the muscles and connective tissue surrounding the shoulder joint can improve stability and relieve nerve pain. Postural assessment and training can help realign the shoulder and surrounding structures.
Manual Therapy: Hands-on treatment can help increase range of motion and restore mobility in a frozen shoulder.
ESWT (Extracorporeal Shock Wave Therapy): ESWT is a painless non-invasive treatment to help relieve pain, increase circulation and promote new cell growth in soft tissues surrounding the shoulder joint.
Dynamic Neuromuscular Stabilization: Restore innate functional movement and correct motor deficiencies with this unique and innovative therapy.
Ultrasound Guided Dry Needling: USGDN targets active myofascial trigger points that tend to arise around injured tissue, contributing to shoulder pain. Ultrasound guidance ensures accuracy and rapid pain relief.
Proteus System: The latest intelligent exercise and rehab technology helps to quickly strengthen the shoulder complex and restore sports movements with patented 3D resistance training and quantitative 3D measurements.
Don’t let shoulder pain keep you from doing the activities you love. The sports shoulder specialists at NYDNR use advanced technologies and clinically proven treatment methods to relive pain and restore shoulder mobility and function, without drugs or surgery. Contact us today for fast and painless shoulder physical therapy.
Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.
Shoulder pain is one of the most common musculoskeletal complaints. It can occur in any age group for various reasons. Most frequently the shoulder pain results from trauma and overuse of the shoulder joint and surrounding tissues. Because of the unique anatomy, versatility and overall importance of the shoulder complex the treatment needs to be multilateral. Spanning across various medical disciplines is essential in order to achieve long-lasting positive effects.
The structure and functionality of the shoulder are unique for human species. The anatomy of shoulder joint is in fact the highlight of human evolution. The versatility and mechanics of the motion of the shoulder is far more complex than of any existing precision machine. Human shoulder joint is one anatomical structure that showed marked morphological changes, compared to the corresponding area in closely related animals, even before the beginning of the vertical life of the mankind.
The evolution of the shoulder anatomy is intimately connected with development of human posture and locomotion. The posture and locomotion depend on neuromuscular coordination of shoulder girdle muscles. These develop in parallel, one slightly preceding another, during the postural ontogenesis that takes place in the first months of infants life mirroring the lengthy process of the human evolution. The stability of the scapula-humeral articulation (shoulder joint complex) during this time defines future posture and locomotion. In fact, the child is not able to walk until he can lift his arm above 120 degrees.
It is a scientific fact that anatomical structures and functions, acquired the latest during the evolution, are the most fragile and prone to failures. The human shoulder is a vivid example of that. The enhanced ability to perform complex multilateral movement has developed at the expense of diminished osteo-ligamentous stability, which is so important for all other joints in human body. At the shoulder, strong bone-and-tendon composition of the joint is replaced by an intricate, if delicate, muscular support mechanism known as the rotator cuff.
The rotator cuff is designed to reinforce the otherwise unsupported shoulder joint and hold the ball-shaped head of the shoulder bone (humerus) in the glenoid fossa, the socket of the shoulder blade (scapula). Rotator cuff is made up of four muscles that originate from the scapula surface and are connected to the upper humerus forming a tight elastic blanket of muscle tissue over the shoulder joint holding it together. Without the rotator cuff support, the head of the humerus would freely ride in and out of the shallow glenoid fossa, rendering the joint inoperable.
The function of the rotator cuff
Rotator Cuff
is not limited to the structural support. Besides keeping the joint intact, the rotator cuff assists in some shoulder and arm movements. During the throwing motion, for example, the rotator cuff muscles undergo series of rapid eccentric contractions (they are lengthened under tension) decelerating the arm and softening the impact of the exertion. Diverse functionality of the shoulder joint puts considerable stress on the tendons of the rotator cuffs muscles making them susceptible to overuse injuries. Relatively poor ability of the rotator cuff tissues to withstand excessive forces is frequently exacerbated by inadequate postural support of the shoulder girdle.
The pain due to rotator cuff tear, tendonitis, various arthritic inflictions and overuse is the price we pay for exchanging structural stability of the shoulder for mobility and motor versatility.
The function of shoulder joint depends not only on the integrity of rotator cuff muscles and sinews, but on the stabilization of the scapula. The ideal position of the scapula is achieved when the body is erect. Poor posture impedes scapular stability, generating excessive loads to the rotator cuff muscles.
For example: Try to lift your arm sideways after slumping your thoracic spine or protruding your chin forward and then compare the results to the range of motion of the same movement during the erect spinal position.
Clinical examination allows diagnostic certainty while further radiological investigation by MRI, and/or diagnostic ultrasound allows diagnostic precision.
The combination of physical therapy and rehabilitation exercise constitute scientifically proven and sound method for treatment of shoulder pain. Many shoulder conditions respond well to extracorporeal shock wave therapy, prolotherapy and platelet-rich plasma injections. Whatever the shoulder pain condition is at stake the combination of any of the above described methods and measured exercise brings the best results.
Shoulder surgery is only necessary when the conservative therapy fails or after a destructive traumatic event. It is a responsibility of a conservative care clinician to make a timely referral for the surgery.
At DN Rehabilitation we use combination of physical therapy exercises, DNS exercises and regenerative treatments such as extracorporeal shockwave therapy, prolotherapy and Platelet-rich Plasma injections. Depending on the diagnosis, individualized treatment plans are developed on the individual basis consisting of balanced combination of the above-listed therapies.
Most conventional physical therapy is based primarily on strengthening of the rotator cuff muscles. DNS approach is different in a way that the treatment begins with restoration of the motor control and muscular synergies before strengthening the rotator cuff. Doing this allows reestablishing muscular balance that is imperative for the ideal function of the shoulder. Muscle synergies that are established during the early childhood development serve as foundation of human posture and movement. During early development muscular synergies around shoulder girdle must develop first to ensure the shoulder stability, which is critical for establishment of the first point of support by the child. DNS reenacts these muscular synergies, reestablishing muscle balance, responsible for ideal function of the shoulder prior to strengthening of rotator cuff.
Professional athletes use DNS therapy and exercises to prevent injuries and, should an injury occur, expedite post-traumatic recovery. The general application of DNS extends far beyond sports medicine and is equally effective for all patient groups.
Regenerative treatment is a form of stimulation of bodys own regenerative abilities by different physical or biological agents introduced into the injured area.
ESWT is used for subacromial bursitis, shoulder tendinitis or calcific tendonitis. Please click here to explore our ESWT page…
Platelet-rich Plasma injections are used for moderate rotator cuff tears and frozen shoulders.
Prolotherapy is used for unstable and hyper mobile shoulders, shoulder dislocations and A-C joint suluxation.
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
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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