Ep. 25: 6 Most Common Shoulder Issues
Hey everyone, HAPPY NEW YEAR!
It’s Dr. Jay Bowen, a board-certified physiatrist here at New Jersey Regenerative Institute, or NJRI.
I work alongside Dr. Thomas Agesen to provide non-surgical solutions to orthopedic problems. Our goal is to help you unlock your intrinsic ability to heal.
Today, we’re kicking off a new series on shoulder pain. Since our 8 most common knee problems video was so successful,
I thought I’d do the same for the shoulder. So, today we’re diving into the 6 most common shoulder issues we see and treat at NJRI.
If you’ve ever dealt with shoulder pain, discomfort, limited mobility, or are just curious about shoulder health, this video is for you. Make sure to subscribe and hit the notification bell so you don’t miss any of our videos. We’ll discuss six shoulder issues, their symptoms, causes, and the best treatment options. Let’s get started!
Impaired Posture and Scapular Dysrhythmia
First, let’s tackle impaired posture and scapular dysrhythmia, which often lead to impingement. Impaired posture refers to abnormal alignment of the head, neck, shoulders, and upper back, which can affect how the shoulder joint functions. This includes forward head posture and rounded shoulders – two VERY common issues
especially with people using laptops, computers, and cell phones. Scapular dysrhythmia refers to abnormal or uncoordinated movement of the scapula or shoulder blade during shoulder motion. The scapula sits on the back side of the ribcage and connects the humerus, or upper arm bone, to the clavicle, or collarbone.
Impaired posture and scapular dysrhythmia are closely connected. Poor posture, especially when sustained over time, can weaken or tighten muscles around the scapula. This imbalance disrupts normal scapular movement patterns, leading to dysfunction and, eventually, shoulder pain. They both usually lead to impingement or pinching of structures, mainly the rotator cuff tendons.
Impingement isn’t a true diagnosis—it’s a mechanical abnormality that results from poor posture or impaired movements during activities that causes the shoulder blade to sit improperly or move inefficiently. The result? Structures like the rotator cuff and bursa can get compressed, leading to pain and limited movement.
Posture and scapular movement are essential for shoulder mechanics. Here at NJRI, we focus on physical therapy and exercises tailored to restore scapular rhythm, address postural deficits, and optimize biomechanics often as a first line recommendation or in combination if additional issues are present.
Biceps Tenosynovitis and the “Popeye Muscle”
Next is biceps tenosynovitis, which can progress to what’s often misdiagnosed as the “Popeye muscle” when it tears.
This condition occurs when the long head of the biceps tendon in the front of the shoulder becomes inflamed or even ruptures at the shoulder, causing a bulge in the biceps.
While it looks dramatic, it’s typically a mechanical and aesthetic issue rather than a severe injury. Treatment ranges from physical therapy to, in rare cases, surgical intervention. If you are old enough to remember Popeye – he had large forearms not a bulge in the biceps, which is why it is a misnomer.
Shoulder Separation (AC Joint Sprain)
Moving on, shoulder separations, or AC joint sprains, happen when the acromioclavicular ligament is injured—often from a fall or impact during sports.
The shoulder is not actually separated from the body.Symptoms include pain over the top of the shoulder, and difficulty lifting the arm. Sometimes there is swelling on top of the shoulder. There are six grades of AC Joint Sprains ranging from a mild sprain where the ligament is stretched, but not torn all the way to severe injuries with significant displacement or damage to surrounding muscles, requiring surgical intervention. One usually will see the end of the collarbone or clavicle sticking up in the most severe cases.
Rotator Cuff Tendinopathy, Bursitis, and Calcific Tendinopathy
Rotator cuff tendinopathy —a spectrum of conditions from tendinitis to tendinosis—is a leading cause of shoulder pain. Bursitis often accompanies it, as inflammation spreads to the bursa. However, a true bursitis in a person without an underlying rheumatological condition is fairly uncommon – the issue is usually with the rotator cuff tendons. Tendinopathy just means “bad tendon” and the subcategories are tendinitis and tendinosis. A tendinitis is also uncommon in people without rheumatological issues. Tendinitis means inflammation of the tendon, which can occur if there is initial trauma, but within 1-2 weeks it has resolved. Most issues are a tendinosis, which means tendon degeneration. These tendon terms are one of the main reasons I am in this area of medicine today. In my residency, I read information by Dr. Nirschl related to tennis elbow noting a lack of inflammatory cells present and that tendonitis is a misnomer. This got me curious about what was happening at a cellular level and why we were using steroids or cortisone, which would be inconsistent with degeneration.
The good news? Most cases improve with conservative treatment like physical therapy to correct mechanics by restoring scapular rhythm, motion, and improve and balance strength. NSAIDS are often used for pain, but they are not just analgesics and can impair recovery as they also inhibit inflammation, which if modulated appropriately direct repair and recovery. At NJRI, we also can add advanced regenerative options for resistant cases. People usually respond to platelet rich plasma or PRP for bursitis around the tendon or into the tendon or tendons for tendinosis. Shockwave can be an option especially if someone is averse to needles.
Some people may have calcium deposits in the tendons called calcific tendinosis and this can be addressed with percutaneous tentomy or shockwave. A percutaneous tentomy uses a needle or device such as Tenex or Ocelot® to break up the calcium and allow healing.
Rotator Cuff Tears
Rotator cuff tears are surprisingly common and don’t always cause symptoms. While many believe surgery is inevitable, that’s not true for most cases. Just think about a study published in 2014. Asymptomatic rotator cuff – means tear(s) without complaints – were present nearly 10% of the time in 20 year olds and increased in frequency each decade to just over 60% by the time people reach their 80s. There are two main types of tears: partial and full.
We focus on non-surgical treatments tailored to restore function and reduce pain, emphasizing physical therapy and patient education. If this more conservative approach does not resolve one’s symptoms, I would generally consider a cellular procedure such as MFAT – microfractured adipose tissue. This acts as an intrinsic scaffold to fill in the gap or tear. Since we have followed patients’ responses, PRP does not usually provide an adequate response for a tear.
Shoulder Arthritis
Lastly, shoulder arthritis—involving the glenohumeral (GH) or acromioclavicular (AC) joints—is a degenerative condition with thinning or loss of cartilage and change in the boney structure causing pain, stiffness, and reduced mobility.
Our approach combines physical therapy, lifestyle modifications, supplements and regenerative treatments to manage symptoms and improve function because the usual option is a total shoulder replacement that is a big surgery and takes 4-6 months or more for full recovery. The regenerative treatments include MFAT, BMAC, or your stem cells, which are often combined with other treatments.
And there you have it—the six most common shoulder issues explained!
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Remember, early diagnosis and treatment are critical for maintaining shoulder health. Be sure to subscribe to our channel so you can follow along over the next 6 weeks as I go more in depth on each of these topics.
If you’re struggling with shoulder pain or dysfunction, we’d love to help. Give the office a call and set up an appointment with myself or Dr.Agesen in Parsippany, NJ.
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