Dear Patients and prospective new clients,

I am writing to inform you that at the end of February, I sustained a serious injury to my left shoulder.   I am doing my best to refer inquiries to other clinics in the area.   I had surgery to repair two torn tendons and some other clean up work in my shoulder at the end of March.  I am planning on returning to my office in September.  Please check back then if you are still seeking help with your problem, or to resume where we left last left off.

A little more about the shoulder:

img3The shoulder is a ball and socket type joint. The “ball” is the head of the humerus, which is your upper arm bone.  The “socket” is the glenoid fossa, which is a shallow cup at the edge of your scapula (aka shoulder blade)  This type of joint offer great mobility at the expense of stability.

long-bone-30-638To simplify a very complex system, I will summarize some important ideas.  In the normal situation, the muscles that support the shoulder joint, the rotator cuff muscles, provide stability to the joint by  pulling the head of the humerus into the socket.  This creates a stable situation so when you use your arm, the ball stays congruent in the socket.  When these stabilizing muscles are not working properly or there is an injury to the shoulder, the ball can ride up in the socket (instability) when using the arm.  The soft tissues on top of the shoulder joint (tendons and bursae) get pinched under the bone arch called the acromial arch.  This condition is called “Impingement syndrome”  and usually develops over time. At first it presents like tendinitis and can go away with proper rest, ice and time.   If untreated or ignored the tendons can get very weak and start to fray and develop microtears which heal with fibrotic tissue leading to what is known as tendinosis.  Eventually they may completely fail and tear through. Most of us over 40 have some degeneration of the tendons under the acromial arch.  Due to the avascular nature of the tissue (very poor blood supply),  things don’t heal up as good as when we were younger, so this condition can either be from an acute trauma or develop slowly over time as a degenerative process….or a little of both.


So, be mindful when using your arms and managing heavy loads.  Avoid repeated overhead  reaching or movements if you already have signs of impingement syndrome.  Strengthen the rotator cuff and work on muscle sequencing and activation because the timing of the muscles is critical to ensure that the rotator cuff is activated first and that the scapula is working in synchrony before moving the arm up and away from the body.


If this isn’t making full sense to you, it would benefit you to see a physical therapist to assess your movement patterns, tendon health and overall upper body strength, endurance and balance. Some sports and occupations predispose one to impingement syndrome like those requiring repetitive overhead activity.

There is much to do on a preventative side and conservative care is recommended before the problem goes beyond being  successfully rehabilitated.

So, don’t ignore shoulder pain.  Get it checked out and take steps in preventing the progression of degenerative changes into full on tears.  Also don’t wrestle with heavy objects, get help if something is beyond your capability to lift, carry or move safely.  It will save you a world of pain and disability.

Cheers to your continued good health,


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