Early diagnosis and intervention for shoulder pain is important to prevent further injury to your rotator cuff.


Shoulder pain greater than 2 weeks that has not resolved should be looked at to prevent a chronic problem and further injury. Most rotator cuff tears start with a chronic mechanical problem with chronic inflammation, pain and swelling that is torn during a routine activity. This is similar to having an alignment issue with your car and noticing tire tread wear. The less efficient your shoulder motion with poor mechanics puts you at risk for ‘wear and tear’ and possible larger injury like a rotator cuff tear. Jason, a personal trainer, shares his story of shoulder issues starting years before he tore his rotator cuff while doing a routine exercise. 


Here is the process of evaluation and treatment.





Your Physical Therapist may decide to conduct a shoulder diagnostic ultrasound. This test is as sensitive as an MRI for picking up rotator cuff tears. Swelling and inflammation can be seen on diagnostic ultrasound. We check to see how your shoulder moves as well to determine if there is a biomechanical problem. If the shoulder diagnostic ultrasound shows inflammation, swelling and even thickening of tendons and bursae, then there is a biomechanical shoulder problem and restoring normal motion through this process will have the greatest chance of success.





Treat the joint limitations that can exist in the glenohumeral joint, shoulder blade or scapula, rib cage and even the spine including the neck. We do this through specific joint manipulation techniques.





There can be trigger points or muscle knots in the shoulder complex, trapezius, rotator cuff and back muscles. Here are some of the treatments that are used to restore normal shoulder muscle mobility and reduce adhesions and restricted and tight connective tissue, even scar tissue.


  • Trigger Point Dry Needling
  • Myofascial Release Technique or Manipulation
  • Active Release type treatment or Functional Techniques
  • Deep Tissue Massage

We recommend dry needling as it speeds up the healing process and will get you better faster.





The next is to work on normal movement and mechanics of the shoulder. This is where you become an integral part of treatment through a home program of using the gained mobility that has occurred through the first two steps. It is important to use the movement that you have been given. Your Physical Therapist will assist you with your technique.




Looking at your posture and postural habits as well as behaviors that may cause a re-injury of your shoulder is important to keep your new shoulder motion and reduced pain from returning. Sleeping posture changes and how you work will be addressed in this part of care.