Shoulder Injuries Treatment

What Causes Shoulder Injuries

The shoulder trades stability for range. The ball sits on a shallow socket and is held in place mostly by muscle and a cuff of four tendons rather than by bone. That design lets you reach overhead, behind your back and across your body, and it is also why the shoulder is injured more often than almost any other joint.

Four problems account for most of what we see at 201 Broadway. Impingement is the rotator cuff tendons and the bursa above them being pinched under the bony roof of the shoulder every time the arm goes overhead; it starts as an ache with reaching and progresses to pain with everything. Rotator cuff tendinopathy and tears range from a tendon that is irritated and thickened to one that is partly or fully torn, with weakness lifting or rotating the arm. Frozen shoulder, or adhesive capsulitis, is the joint capsule itself thickening and contracting, so that motion is lost in every direction and not just the painful ones; it is more common in people in their 40s to 60s and in patients with diabetes or thyroid disease. Bursitis is inflammation of the fluid-filled sac that cushions the tendons, and it usually travels with one of the other three.

Most of these have a mechanical cause behind them. A stiff upper back and a forward head posture, the standard result of a long day at a Kendall Square desk or in a lab bench, tilt the shoulder blade forward and narrow the space the tendons move through. Climbers at the local gyms, swimmers at the Harvard and MIT pools, and anyone whose sport or job keeps the arm overhead load the cuff faster than it adapts. Falls on winter ice onto an outstretched arm produce the acute tears and the occasional separation. Shoveling the driveway after a nor'easter produces its own cluster every January.

Pain in the shoulder is also sometimes not a shoulder problem. A pinched nerve in the neck refers into the shoulder and upper arm, and the shoulder itself examines normally. Sorting that out is part of every first visit.

How We Diagnose It at 201 Broadway

Dr. Bromberg takes the history himself. He asks when it started, whether there was a fall or a single moment, what movements hurt (reaching overhead, reaching behind to a back pocket or a bra strap, lying on that side), whether it wakes you at night, and whether there is any numbness or tingling in the arm or hand. Night pain and the painful arc of reaching are particularly informative. He also asks about diabetes and thyroid history because of their link to frozen shoulder.

The exam compares both shoulders. He watches how the shoulder blade moves as you raise the arm, measures range of motion actively (you move it) and passively (he moves it), and tests the strength of each rotator cuff tendon in isolation. The pattern separates the main causes: impingement hurts in a specific arc and usually keeps its passive range, a torn cuff is weak in one direction out of proportion to the pain, and a frozen shoulder loses passive motion in every direction, especially external rotation. He palpates the tendons, the bursa, the biceps groove and the AC joint at the top of the shoulder.

Every shoulder exam here includes the neck. He checks cervical range of motion, and runs a neurological screen of reflexes, sensation and strength in the arm, because a cervical nerve root can produce shoulder pain that no amount of shoulder treatment will fix. He also examines the upper back and ribs, which set the platform the shoulder blade sits on.

Imaging is ordered when it would change the plan. An X-ray is useful after a fall, for suspected arthritis or calcific tendinitis, and in older patients. An MRI is ordered when the exam suggests a significant rotator cuff or labral tear, or when a shoulder that should be improving is not. He refers to an area imaging center and reviews the results with you himself. For most impingement and early frozen shoulder cases, the exam is enough to begin.

How We Treat Shoulder Injuries

Treatment is matched to the diagnosis, because impingement, a cuff tear and a frozen shoulder each need something different.

Active Release Technique is central to shoulder care here. The rotator cuff, the muscles that control the shoulder blade, the pectoralis minor at the front of the shoulder and the latissimus underneath all develop adhesions with overuse and injury, and those adhesions restrict motion and alter how the joint tracks. ART releases them by applying pressure to the restricted tissue while the arm moves through its range. For impingement it opens the space the tendons move through; for a healing cuff it keeps the repair from binding down; for frozen shoulder it works on the muscles that have shortened around the stiff capsule.

Adjustments address the joints that set the shoulder up. The upper thoracic spine, the ribs and the neck are where most shoulder patients are restricted, and restoring their motion changes the position of the shoulder blade and the arc the arm can travel through. The shoulder joint itself and the AC joint are mobilized gently when they are stiff. He does not perform forceful manipulation on an acutely inflamed or unstable shoulder.

Rehab is specific to the diagnosis. Impingement responds to scapular stabilization and cuff strengthening in positions that do not pinch. A cuff tendinopathy needs progressive loading of the tendon. Frozen shoulder needs patient, repeated range of motion work within tolerance, in every direction, for months. You learn the exercises here and do them at home between visits; the home work does more than any single office visit.

Workstation and sleep position changes are part of the plan for most patients. For detail on specific conditions, see our posts on shoulder impingement treatment and frozen shoulder and rotator cuff treatment.

What Your Visits Look Like

The first visit covers the history, the shoulder and neck exam, the neurological screen, an explanation of what Dr. Bromberg found and why, and in most cases a first treatment the same day. Wear or bring a top that lets him see the shoulder blade. Bring any imaging reports or notes from other providers. No referral is needed in Massachusetts.

Follow-ups are shorter. He rechecks your range of motion and strength, treats with ART and adjustments as indicated, and advances the home program. Impingement and bursitis are typically seen once or twice a week for four to eight weeks. Rotator cuff tendinopathy runs similar or somewhat longer. Frozen shoulder is a different animal: the condition has a long natural course and visits are spaced out over several months, with the goal of keeping motion gains and preventing the capsule from tightening further between visits. Dr. Bromberg sees every patient personally at every visit.

Progress is measured in degrees and in function. He records how far you can raise the arm, rotate it outward and reach behind your back, and tracks night pain, sleep, and the tasks you have regained: putting on a coat, reaching the top shelf, a full set of pull-ups at the gym. If those numbers do not move over a reasonable span, the plan changes rather than continuing on hope. No prepaid packages; your plan is reassessed on real progress.

We are a 6-minute walk from the Kendall/MIT Red Line station with free and metered street parking on Broadway. Same-day slots are held for patients in pain.

What to Expect: Outcomes and Timelines

Impingement and bursitis usually improve noticeably within three to four weeks and resolve over six to ten weeks when the mechanical cause is addressed and the home program is done. Rotator cuff tendinopathy without a significant tear takes longer, often eight to twelve weeks, because tendon remodels slowly. Partial tears can do well with conservative care and strengthening of the remaining cuff, and many patients with partial tears never need surgery.

Frozen shoulder is the one where expectations need to be set carefully. Its natural course runs from months to a couple of years through a painful phase, a stiff phase and a thawing phase. Treatment shortens that course and keeps you more functional through it, but it does not make a frozen shoulder resolve in six weeks, and we will not tell you it does. Patients with diabetes tend to run longer.

What slows recovery: continuing to work overhead at full volume, skipping the home exercises, sleeping on the painful side, an untreated neck or upper back restriction, and waiting months before being evaluated. A cuff that has been impinging for a year has often started to fray, and that is harder to settle than one seen in the first month.

The plan changes when progress stalls. Dr. Bromberg re-examines, orders imaging if it was not needed at the start, and refers when that is the right call. He refers to orthopedics for a suspected full-thickness rotator cuff tear, particularly in younger or active patients where early repair matters, for a labral tear with instability, for a shoulder that dislocates, and for frozen shoulder that is not responding, where a steroid injection or capsular release may be considered. He works alongside physical therapists when a patient needs more supervised exercise time than one office provides, and he will tell you plainly if he thinks surgery is the better path.

When to See Someone Else First

Some shoulder problems should go to urgent care, the emergency room or an orthopedic office before they come to a chiropractor. Go there first if you have:

• A visible deformity or a shoulder that looks out of its socket after a fall or impact
• Sudden inability to lift the arm at all after an injury, which can mean a complete rotator cuff tear or a fracture
• A fall onto the shoulder in a patient over 65, or on blood thinners, or with a known bone density problem
• A hot, red, swollen shoulder with fever or feeling unwell, which can be a joint infection
• Shoulder or arm pain that comes on with exertion, with chest pressure, shortness of breath, sweating or nausea, which is a possible heart problem and is a 911 call
• Numbness, tingling or weakness spreading down the arm that is getting worse, or weakness in both arms
• A lump, unexplained weight loss, or night pain in a patient with a cancer history

Once a fracture, dislocation, full tear or medical cause has been ruled out, most of what remains is impingement, tendinopathy, bursitis or frozen shoulder, and that is what we treat. Call (617) 494-1166 or walk in on Monday, Wednesday or Friday during office hours.