Shoulder Pain Treatment in Royal Palm Beach, FL
Shoulder pain requires a careful distinction: is the problem in the shoulder itself, or is it referred pain from the cervical spine? The answer changes everything.
Shoulder pain treatment in Royal Palm Beach, FL at Cobblestone Spine and Joint Institute starts with a diagnostic question that most patients have never been asked: is the pain actually coming from the shoulder, or is it being generated by the cervical spine and referred into the shoulder region? The answer fundamentally changes the treatment.
The C5 nerve root, which exits the cervical spine between the fourth and fifth vertebrae, refers pain directly to the shoulder and upper arm. A C5-C6 disc herniation can produce shoulder pain, deltoid weakness, and biceps reflex changes that are nearly indistinguishable from rotator cuff pathology on clinical presentation. Treating a cervical disc problem as a shoulder problem produces no improvement, no matter how good the shoulder treatment is.
Dr. Dean Mammales performs a full cervical and shoulder examination on every shoulder pain patient before making any treatment decisions.
Shoulder Pain Presentations We Treat
Acute or chronic overload injury to one or more of the four rotator cuff muscles. Common in throwing athletes, overhead workers, and after falls.
Compression of the rotator cuff tendons in the subacromial space. Often caused by scapular mechanics, not the shoulder joint itself.
Pain generated by a cervical disc herniation or nerve root irritation that presents as shoulder or upper arm pain. Requires cervical treatment, not shoulder treatment.
Adhesive capsulitis producing progressive loss of shoulder range of motion. Manual therapy and specific joint mobilization are highly effective in the early and middle stages.
Injury to the acromioclavicular joint from a fall or direct impact. Responds well to conservative care in most cases.
Chronic overload of the biceps tendon at its attachment point. Responds well to MLS laser combined with load management.
The Scapula Problem Nobody Addresses
Shoulder impingement is one of the most commonly treated shoulder conditions. And it is also one of the most commonly treated incorrectly. True subacromial impingement involves compression of the rotator cuff tendons as the arm is elevated. But the vast majority of shoulder impingement cases are not caused by a structural problem in the shoulder. They are caused by poor scapular mechanics. If the scapula is not rotating properly as the arm elevates, the subacromial space closes abnormally and compresses the tendons regardless of the shoulder joint anatomy.
Poor scapular mechanics almost always trace to mid-thoracic spine restriction and weakness of the serratus anterior and lower trapezius muscles. Adjusting the thoracic spine to restore normal segmental motion, combined with targeted strengthening of the scapular stabilizers, resolves the impingement by addressing its actual cause. We treat a lot of shoulder patients who have had years of shoulder-focused treatment that never addressed the thoracic spine. The improvement after we do is typically rapid and dramatic.
A Royal Palm Beach Softball Player
A patient who plays in an adult recreational softball league near Royal Palm Beach Commons came to us with chronic right shoulder pain that had been present for most of a season. He had been told by an orthopedist that he had subacromial impingement and was given a cortisone injection, which helped for six weeks and then wore off. He was told a second injection was available if needed.
Examination found significant mid-thoracic restriction at T3-T4 and T5-T6, combined with marked lower trapezius weakness. His scapula was winging visibly on overhead elevation and the supraspinatus was being compressed in the narrow subacromial space this created. Four weeks of thoracic manipulation and scapular stabilization work resolved the impingement symptoms. He finished the season without any further shoulder problems. The cortisone had been treating the inflammation caused by the impingement while the mechanical cause continued producing it.
MLS Laser for Shoulder Pain
For inflammatory shoulder conditions including rotator cuff tendinopathy, bicipital tendinitis, and bursitis, MLS laser therapy reduces pain and inflammation effectively. It accelerates the treatment timeline when combined with the mechanical corrections described above. Call (561) 753-2225 or book here.
Shoulder Pain Requires the Right Diagnosis First.
We evaluate the cervical spine and the shoulder together. That distinction matters. Same-week appointments available.