Persistent Shoulder Pain

Shoulder tendonitis/ impingement pain Our office phone 727 548-1111

Do you know that there are more than eight
 major tendons just around your shoulder area?  And about 30 millions adults in America suffers shoulder pain at any time.  The recurrence rates are as high as 25% and more than half of patients told us that the pain is persistent and lasts more than 12 months. The shoulder tendons wears out and can look like frayed strings?
As we grow up, are you aware that our tendons are worn out and they can look like ragged fabrics?
That’s a lot of tendons in a narrow area about 4 square inches. Some shoulder tendons pile on top of others, then the axial nerve and ulnar nerve, plus arm arteries have to find their own path to function properly.  All these critical muscles, tendons, nerves and blood vessels crisscross each others to help rotate and lift the arm.   

There are a lot of Americans suffer from shoulder tendonitis,  a very common ailment, and lots of office visits and therapies.
Once, patients have sharp pain around shoulder, they cannot lift the arm, rotate the elbow, and their arm’s range of motion is limited.  Sleep is difficult because you cannot turn or change sleep position at ease and patients become grumpy due to sleep disturbance.
Physical therapy can make it better and other times can make it worse because patients try to push it thru the pain which is not a good idea.  Pain gets more pain. And pretty soon the small tear become a scar and refuse to heal properly.
Tendons are extensions at end of muscles that connect the muscles to bone. Tendon is very tough fibrous cord and flexible. Tendons are made out of collagen.  Tendon does not have a lot of blood supply and not easy to heal.
Tendonitis is an inflammatory condition affecting the tendon’s tissues. Tendonitis occurs when the joints in the body have been overused.
Don’t shrug of shoulder pain. Pain in this joint can curb your independence. Catch problems early, build joint strength and avoid injury.
It’s easy to take your shoulders for granted. You don’t think about them when you put your arm through a sleeve or reach out for something. But weak or injured shoulders can limit your daily function and rob you of your independence. You may not be able to open a door, push up from a chair or a couch, or tuck in your shirt without wincing in pain.

Top of Shoulder Pain

The susceptible joint

We think of the shoulders as a center of strength (hence, the common expression “to shoulder a load”). In reality, the shoulder joint is susceptible to harm, especially as we grow. Wear and tear may cause arthritis — a decrease in the cartilage that cushions the shoulder bones (the acromion and shoulder blade). Symptoms include pain, stiffness, and reduced range of motion.

The four tendons and four muscles that stabilize and help rotate your shoulder (known collectively as the rotator cuff) also deteriorate with age, putting us at risk for tears after years of use and overuse. Most tears do not require surgery. When trauma causes a tear through the full thickness of the rotator cuff, surgery typically is necessary.

Other generators of pain

Sinking neck in shoulders and unbalanced back can lead to other causes of shoulder pain. “Everything we do with our arm is in front of us, and that builds up the pectoral muscles in the chest. They get tight over time, and pull the shoulders forward,” explains therapist. As a result, the rotator cuff muscles can get pinched underneath the shoulder blade and collarbone, causing pain and inflammation known as impingement. When impingement continues, it can lead to degradation and ripping and tearing of the rotator shoulder tendons. Shoulder impingement syndrome occurs as the result of chronic and repetitive compression or “impingement” of the rotator-cuff tendons in the shoulder, causing pain and movement problems. It can also be caused by an injury to the shoulder. People who perform repetitive or overhead arm movements, such as manual laborers or athletes who raise their arms repeatedly overhead (ie, weightlifters and baseball pitchers), are most at risk for developing a shoulder impingement.

The bursa — small, fluid-filled sacs in the shoulder — can also become pinched and inflamed, causing pain. The condition is called bursitis.


If your shoulder joint aches for more than a few weeks, it’s probably time to see your doctor. The first line of treatment is over the counter pain relief, and a course of physical therapy that lasts about six to 12 weeks.

For shoulder nerve impingement, treatment may include a cortisone injection first to counter inflammation, and then physical therapy when inflammation subsides. The therapists needs to work with reducing inflammation as priority.

Treatment for tendinitis may also start by resting the shoulder and giving inflammation a chance to go down.

What’s involved with Physical Therapy?

Physical therapy focuses on strengthening the rotator cuff muscles (such as the infraspinatus and supraspinatus) and the shoulder blade muscles (such as the lower and middle trapezius), training about proper posture, then increasing your range of motion with exercises that rotate the shoulder.

Learning proper posture is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become impinged. Your physical therapist will work with you to help improve your posture, and may suggest adjustments to your work station and work habits.

Functional Training. As your symptoms improve, your physical therapist will teach you how to correctly perform a range of functions using proper shoulder mechanics, such as lifting an object onto a shelf or throwing a ball. This training will help you return to pain-free function on the job, at home, and when playing sports.

To improve posture, for example, a therapist might have you do a shoulder blade squeeze, in which you squeeze your shoulder blades together for 60 seconds, and then relax.

Final thoughts

To reduce shoulder pain and injury in the future, you’ll need to continue doing shoulder exercises at home after physical therapy ends. “You’ll have to be consistent, and exercise your shoulders two or three times per week for the long term,” doctor of orthopedist says. Shoulder pain can be dynamic meaning it can be radiated from the neck muscles and nerves. If you suffer pain for more than three months, you may need to see doctor. Our office has medical specialists who will listen to you to discuss the proper treatment for you chronic shoulder pain or neck pain. Please give us a call NOW 727 548-1111.