Shoulder Pain

The most mobile joint in your body

The shoulder trades stability for mobility. It's a ball-and-socket joint with a relatively shallow socket, which lets you reach overhead, behind your back, and across your body — but it also means the surrounding muscles, tendons, and ligaments have to work overtime to keep everything centered and moving well.

When something goes wrong, it's rarely just one structure. The shoulder is a system: the glenohumeral joint, the scapula and the muscles that control it, the acromioclavicular joint, the cervical and thoracic spine, and the rib cage all have to coordinate. Shoulder pain is usually a breakdown in that coordination.

Common causes

Rotator cuff dysfunction. The four rotator cuff muscles hold the humeral head centered in the socket during movement. When they're weak, irritated, or torn, you'll feel pain with reaching, lifting, and especially overhead activity. Partial tears and tendinopathy are far more common than complete tears.

Shoulder impingement. This happens when the space between the top of your humerus and the acromion narrows, pinching the rotator cuff tendons and bursa during elevation. It's often a biomechanical problem — poor scapular control, a stiff thoracic spine, or a restricted first rib can all reduce that space.

Adhesive capsulitis (frozen shoulder). The capsule surrounding the joint gradually stiffens, causing a progressive loss of range of motion in all directions. It tends to come on slowly, is more common in women and in people with diabetes or thyroid disorders, and follows a predictable course of freezing, frozen, and thawing phases.

AC joint dysfunction. The small joint where your collarbone meets the top of your shoulder blade can become irritated from repetitive overhead activity, direct trauma, or degenerative changes. It causes localized pain at the top of the shoulder, especially with reaching across the body.

Referred pain from the neck. Not all shoulder pain comes from the shoulder. Cervical disc herniations and nerve root irritation can refer pain into the deltoid and upper arm in a pattern that mimics rotator cuff disease. If your shoulder exam is surprisingly normal but the pain persists, we look at the neck.

How we approach it

I look at the whole system. That means evaluating the thoracic spine, the ribs, the scapular mechanics, and the cervical spine in addition to the shoulder itself. A shoulder that hurts during elevation might improve immediately when we restore motion to the upper thoracic spine or release a restricted first rib.

OMM addresses the joint restrictions and fascial tension that are limiting normal movement patterns. If we need to target something more precisely — a bursa, a tendon, the AC joint — ultrasound-guided injections let us deliver treatment to exactly the right structure. Shockwave therapy is particularly effective for chronic rotator cuff tendinopathy and calcific tendinitis.

When to seek care

See us if your shoulder pain is limiting what you can do with your arm, if you can't sleep on the affected side, if you notice your range of motion is gradually decreasing, or if you had an injury and the pain hasn't resolved in a couple of weeks. Shoulder problems tend to get more complicated the longer they go unaddressed.

What you can do right now

Stop pushing through pain with overhead pressing or bench press. These exercises can be great for the shoulder when the mechanics are right, but they make things worse when something is already irritated.

Work on your thoracic mobility. If your upper back is stiff, your shoulder blade can't move properly, and your rotator cuff has to compensate. Cat-cow stretches, thoracic rotations, and foam roller extensions can all help.

Strengthen the scapular stabilizers. Exercises that target the lower trapezius and serratus anterior — like wall slides and serratus punches — are more useful for most shoulder problems than traditional rotator cuff isolation exercises.