Shoulders

Common Shoulder Conditions

Shoulder pain and injury often involve one of several common conditions:

Rotator Cuff Tear

• Symptoms:
  Pain, weakness, difficulty lifting the arm, clicking or popping.
• Treatment:
  Physical therapy, injections, or arthroscopic repair.

A tear (partial or complete) in the rotator cuff tendons. This usually causes shoulder pain and weakness, especially when lifting or rotating the arm. Patients may struggle to raise the arm and often feel increased pain at night or with activity. In some cases, they hear clicking or popping. Rotator cuff tears become more common with age or repetitive overuse.

SLAP Tear

• Symptoms:
  Deep pain, catching or locking, instability.
• Common in:
  Overhead athletes.
• Treatment:
  Physical therapy, injections, or surgical repair.

A SLAP tear is a specific injury to the labrum (cartilage rim) in the shoulder, often at the point where the biceps tendon attaches. SLAP tears (“Superior Labrum Anterior and Posterior”) commonly occur in overhead athletes. Symptoms include deep shoulder pain, a catching or locking feeling, and instability. Unlike rotator cuff tears (which weaken lifting), a SLAP tear often causes a “grinding” or instability sensation. Both injuries can cause pain with arm movement, but SLAP tears are labrum/cartilage injuries whereas rotator cuff tears involve the muscle tendons.

Shoulder Impingement Syndrome

• Symptoms:
  Pain when lifting the arm or lying on the shoulder.
• Causes:
  Bone spurs, poor posture, repetitive overhead activity.
• Treatment:
  Anti-inflammatory medications, physical therapy, posture correction.

Occurs when shoulder motions (often overhead reaching) pinch the rotator cuff tendons under the acromion. Essentially, the acromion (a bony projection of the scapula) rubs or presses on the swollen tendons or bursa. This “impingement” leads to inflammation and pain. Patients typically feel pain in the front or top of the shoulder that worsens when lifting the arm or lying on that side. Impingement is very common and can be related to bone spurs or posture.

Frozen Shoulder

• Symptoms:
  Severe pain, limited range of motion, especially at night.
• Treatment:
  Stretching, physical therapy, anti-inflammatory medications, steroid injections.

A condition in which the shoulder capsule becomes inflamed and stiff over time. The two hallmark symptoms are severe shoulder pain and progressive loss of range of motion. The pain is often worse at night and can “freeze” the joint, making it hard to move the arm. Frozen shoulder can last for many months. Treatment focuses on pain relief and restoring motion – for example, gentle shoulder stretching exercises, and often a course of physical therapy. Doctors may also use anti-inflammatory treatments (NSAIDs, steroid injections) to reduce pain.

Shoulder Arthritis

• Symptoms:
  Chronic pain, stiffness, reduced mobility.
• Treatment:
  Medications, injections, physical therapy, or shoulder replacement surgery.

Degenerative changes (osteoarthritis or rheumatoid arthritis) in the shoulder joint cause chronic pain, stiffness, and reduced motion. As the cartilage wears away, bone-on-bone contact produces aching pain that typically worsens with activity. Arthritis pain relief may involve anti-inflammatory medications, injections, and exercise. In severe cases where arthritis is disabling, shoulder replacement surgery (arthroplasty) is indicated. This replaces the damaged joint surfaces with metal/plastic implants. Most patients experience dramatically reduced pain and improved function after recovering from shoulder replacement.

Bursitis

• Symptoms:
  Tenderness, pain with overhead movement.
• Treatment:
  Rest, ice, anti-inflammatory medications, cortisone injections.

Inflammation of one of the shoulder’s bursae (fluid sacs that reduce friction). The most common is subacromial bursitis. Symptoms mimic impingement: shoulder pain and tenderness, especially when moving the arm overhead. In fact, swelling of the bursa can contribute to impingement symptoms. Bursitis treatment involves rest, ice, medications, and sometimes a cortisone injection to the bursa.

Shoulder Dislocation

• Symptoms: 
  Sudden pain, visible deformity, inability to move the arm.
• Treatment: 
  Reduction (repositioning), immobilization, and physical therapy.

A traumatic injury where the humeral head is forced out of the socket. This causes immediate pain and loss of function. After reduction (putting the joint back in place), the shoulder is usually immobilized for some time. Recovery from a dislocation typically takes several months. The arm is kept in a sling for a few weeks, followed by physical therapy to regain motion and strength. Most patients need a few months of rehab before returning to normal activities.

Treatment depends on the condition’s severity

Non-surgical treatments

For many shoulder problems, conservative care is first line. This includes rest, ice/heat, and NSAID pain medications. Physical therapy exercises (especially for rotator cuff and tendonitis) are key – stretching and strengthening the shoulder muscles can relieve pain and improve function. For example, guided shoulder tendonitis exercises can reduce inflammation and prevent re-injury. Other non-surgical modalities include ultrasound or electrical stimulation as prescribed by a therapist.

Cortisone (Steroid) Injection in Shoulder:

A doctor may inject a corticosteroid into the shoulder joint or bursa to reduce inflammation. A cortisone shot often provides quick pain relief for bursitis, tendonitis, or arthritis, typically lasting weeks to months. It is commonly used when other measures have not adequately controlled pain.

Platelet-Rich Plasma (PRP) Injection:

PRP therapy uses the patient’s own blood, concentrated with platelets, to promote healing of chronic tendon and muscle injuries. When injected into a damaged tendon or muscle (such as a partial rotator cuff tear), PRP can accelerate tissue repair. Recent studies and clinical practice have shown promising results of PRP for shoulder tendon injuries. (This is an emerging treatment and may not be covered by all insurances.)

Arthroscopic (Minimally Invasive) Shoulder Surgery:

Many shoulder problems can be treated arthroscopically. In this approach, the surgeon makes small incisions and uses a tiny camera. Common arthroscopic procedures include rotator cuff repair, labral repair (for SLAP tears), debridement of frayed tissue, or subacromial decompression for impingement. Minimally invasive surgery generally leads to less pain and faster recovery than open surgery. Rehabilitation still follows (see below), but patients often return to normal use faster than with traditional open surgery.

Rotator Cuff Repair Surgery:

For large or symptomatic rotator cuff tears, surgical repair may be recommended. Using arthroscopy (or occasionally a small open incision), the surgeon re-attaches the torn tendon back to the humerus. After rotator cuff repair, the arm is placed in a sling for several weeks. Physical therapy is then slowly introduced: first gentle passive motion, then active exercises to strengthen the cuff. Full recovery (return of strength and function) can take several months, often 3–6 months of rehabilitation.

Shoulder Replacement Surgery:

As noted above, total shoulder arthroplasty replaces worn joint surfaces with an artificial prosthesis. This is reserved for severe arthritis or irreparable cuff tear arthropathy. The surgery usually lasts a couple of hours.

Afterward, patients stay in the hospital

(1–3 days) before beginning physical therapy. Most people notice a dramatic reduction in shoulder pain after healing. Rehabilitation is gradual: initially focus on gentle range-of-motion exercises, then strengthening over the following months. By about 3–6 months post-op, many patients have regained significant function.

Recovery & Rehabilitation

No matter the treatment path—whether surgical or non-surgical—rehabilitation is essential to restoring shoulder function and preventing long-term complications. At our clinic, we work closely with experienced physical therapists to guide each patient through a personalized recovery plan.

Phases of Recovery

Rehabilitation typically progresses through several key stages:

• Early Phase:
  Focuses on reducing pain and inflammation while gently restoring range of motion. This often includes passive movements, where the therapist assists in moving the arm to avoid strain.
• Intermediate Phase:
  As healing progresses, patients begin active movements—using their own muscles to move the shoulder. This helps rebuild coordination and control.
• Strengthening Phase:
  Gradual introduction of resistance exercises helps restore strength, stability, and endurance. This phase is especially important for athletes or individuals returning to physically demanding activities.

Timeline and Expectations:

Recovery timelines vary depending on the severity of the injury and the type of treatment. For example, full recovery after shoulder surgery or a major dislocation can take several months. Athletes may require additional time and sport-specific rehab to safely return to play.

Why Rehab Matters:

Consistent physical therapy is key to preventing complications like stiffness or frozen shoulder. It also helps patients regain full function, reduce the risk of re-injury, and achieve the best possible long-term outcome.