The shoulder is the most mobile joint in your body — and one of the most commonly injured. Learn about your diagnosis and your options, explained in plain language.
The rotator cuff is a group of four muscles and their tendons that wrap around the ball of the shoulder joint, holding it in place and powering arm movement. A rotator cuff tear — either from a sudden injury or gradual wear — is one of the most common causes of shoulder pain and weakness, affecting about 2 million Americans each year. Tears range from partial thickness (incomplete) to full thickness (complete).
How It Happens
Acute injury: falling on an outstretched arm, or a sudden pulling or lifting force
Degenerative tear: gradual fraying of the tendon over years — very common after age 60
Prior shoulder impingement can weaken the tendon over time
What You'll Feel
Dull ache deep in the shoulder, often worse at night and when lying on the affected side
Weakness when lifting the arm or reaching overhead
Difficulty with everyday tasks: reaching into a back pocket, washing hair, reaching a shelf
A snapping or crackling sensation with shoulder movement
Acute tears often cause sudden, severe pain and dramatic weakness
Diagnosis: A physical exam tests strength and range of motion. MRI is the gold standard to confirm a tear, determine its size, and assess the quality of the muscle — all of which guide treatment decisions.
Treatment Options
Non-Surgical
Appropriate for partial tears, small full-thickness tears, or patients with low demands
Physical therapy to strengthen the remaining rotator cuff muscles
Anti-inflammatory medications and activity modification
Cortisone injection for pain relief and to enable participation in PT
Important: non-surgical treatment does not heal the tear — it manages symptoms
Surgical
Arthroscopic rotator cuff repair — the torn tendon is reattached to the bone using suture anchors, through small keyhole incisions
Highly effective: >85–90% of patients report significant pain relief and improved strength
Best results when the tear is repaired before the muscle becomes too weak or the tendon retracts too far
Larger, chronic tears may require augmentation with a patch or alternative techniques
Outpatient procedure; arm placed in a sling post-operatively
RecoverySling use for 4–6 weeks to protect the repair. Active PT begins at 6 weeks. Most patients return to full overhead activity and sport in 4–6 months. Tendon-to-bone healing takes 3–6 months regardless of how good you feel.
Shoulder pain at night or difficulty reaching overhead are classic signs. Don't wait — tears tend to grow over time.
The labrum is a ring of fibrocartilage that lines the rim of the shoulder socket, deepening it and helping to keep the ball in place. A labral tear reduces shoulder stability and can cause pain, clicking, and a sense that the shoulder is "catching" or about to give way. The two most common types are SLAP tears (top of the labrum, common in overhead athletes and from falls) and Bankart tears (front of the labrum, common after shoulder dislocations).
Gradual degeneration — more common in adults over 40
What You'll Feel
Deep, aching pain in the shoulder — hard to pinpoint
Pain with overhead activity, reaching behind the back, or throwing
Clicking, popping, or grinding inside the joint
A feeling of instability or looseness
Decreased throwing velocity or accuracy in athletes
Treatment Options
Non-Surgical
Many labral tears — especially degenerative SLAP tears in adults — respond well to conservative care
Physical therapy focused on rotator cuff and periscapular strengthening
Cortisone injection for pain reduction
Activity modification — avoiding overhead positions that provoke symptoms
Surgical
Labral repair (Bankart or SLAP): The torn labrum is reattached to the bone using small anchors, all arthroscopically
Biceps tenodesis (rather than repair) may be recommended for SLAP tears in adults over 35–40, where repair has lower success rates
Bankart repair is highly effective for young patients after a shoulder dislocation — dramatically reduces re-dislocation risk
Latarjet procedure for patients with significant bone loss on the socket
RecoverySling for 4–6 weeks, then progressive PT. Overhead athletes typically return to throwing in 4–6 months and to competition in 6–9 months.
Shoulder · Dislocation
Shoulder Instability & Dislocation
A shoulder dislocation occurs when the ball of the upper arm bone is forced out of the shoulder socket — almost always to the front. It is the most commonly dislocated large joint in the body. After a first dislocation, the risk of it happening again is high — especially in young, active patients. Recurrent instability can damage the labrum, cartilage, and bony structures of the shoulder over time.
How It Happens
A fall on an outstretched arm
A direct blow to the shoulder
A forceful throw or reach
After the first dislocation, the shoulder can become loose enough to dislocate again with much less force
Some people have naturally loose shoulders (hyperlaxity) and are prone without trauma
What You'll Feel
Immediate, severe pain at the time of dislocation
The arm is held in an unusual position
Visible deformity of the shoulder
After reduction: ongoing pain, swelling, and weakness
With recurrent instability: a feeling the shoulder is "slipping," apprehension when reaching behind or overhead
Important statistic: The risk of re-dislocation after a first event is ~50–90% in patients under 20 and decreases with age. Early surgical stabilization dramatically reduces recurrence in young athletes — from over 70% down to under 10%.
Treatment Options
Non-Surgical (First-Time, Older Adults)
Reduction: putting the shoulder back in place (done in the ER or by Dr. McLaughlin)
Brief immobilization in a sling for comfort
Physical therapy to restore strength and reduce risk of recurrence
May be appropriate for first-time dislocation in lower-demand adults
Surgical (Recurrent / Young Active Patients)
Arthroscopic Bankart Repair: The torn front labrum is reattached — highly effective for restoring stability when bone loss is minimal
Latarjet Procedure: A bone graft is moved to the front of the socket to add depth and a "seatbelt" effect — used when there is significant bone loss or high-risk sport involvement
Return to contact sport or military service is generally better achieved with surgery than PT alone for young, active patients
RecoverySling for 4–6 weeks, then PT. Return to non-contact sport: 4–5 months. Return to contact sport or overhead throwing: 5–6 months.
Shoulder · Overuse
Shoulder Impingement & Bursitis
Shoulder impingement occurs when the tendons of the rotator cuff get pinched between the ball of the shoulder and the bony roof above it (the acromion) during arm elevation. This repetitive pinching irritates the tendons and the bursa — a small fluid-filled sac that normally allows the rotator cuff to glide smoothly. Bursitis and impingement are among the most common causes of shoulder pain and are highly treatable, usually without surgery.
Workers with repetitive overhead tasks: painters, electricians, construction
A hooked or curved acromion shape increases the risk
Weak rotator cuff or periscapular muscles that allow poor shoulder mechanics
What You'll Feel
A painful arc — pain when lifting the arm between 60–120 degrees (like a windshield wiper arc)
Pain reaching overhead or across the body
Night pain — difficulty sleeping on the affected shoulder
Mild to moderate weakness with overhead activity
Gradual onset — not typically associated with a single traumatic event
Treatment Options
Non-Surgical (First-Line — Most Patients Improve)
Physical therapy: the cornerstone of treatment — focused on rotator cuff and scapular strengthening and correcting movement patterns
Activity modification to avoid provocative positions
Anti-inflammatory medications (NSAIDs) for pain relief
Corticosteroid injection into the bursa — provides relief while PT takes effect
The vast majority of patients improve significantly within 4–8 weeks of consistent PT
Surgical (Failure of Conservative Care)
Arthroscopic subacromial decompression — smoothing the undersurface of the acromion to create more space for the rotator cuff
Bursectomy — removing the inflamed bursa
Surgery is considered after 3–6 months of failed conservative treatment
Outpatient procedure with a faster recovery than rotator cuff repair
RecoveryMost patients see significant improvement with PT in 6–12 weeks. If surgery is needed, most patients return to full activity in 2–4 months.
Shoulder · Tendon
Biceps Tendon Injury
The biceps muscle has two tendons — one attaches at the elbow and one (the "long head") passes through the shoulder joint and attaches at the top of the socket. The long head biceps tendon is frequently a source of shoulder pain, especially in middle-aged and older adults. It can become inflamed, partially torn, or completely rupture. A "Popeye deformity" — where the biceps muscle bunches up toward the elbow — is a sign of a complete rupture.
How It Happens
Chronic tendinitis from repetitive overhead use or impingement
Sudden rupture from a heavy lift or sudden force
Often associated with rotator cuff tears or SLAP tears
More common in men over 40
What You'll Feel
Pain at the front of the shoulder — often a sharp, catching pain
Tenderness over the front of the shoulder in the bicipital groove
Pain with lifting, overhead activity, or twisting the forearm
Complete rupture: a sudden "pop," bruising, and the Popeye deformity (muscle bunching at the elbow)
Complete rupture in older, lower-demand patients: many tolerate this well without surgery — some mild strength loss but minimal functional deficit
Surgical
Biceps Tenotomy: Simply releasing the tendon from its attachment in the shoulder — quick recovery, small risk of the Popeye deformity
Biceps Tenodesis: The tendon is detached and re-anchored lower on the bone — maintains normal appearance and preserves more strength. Preferred in younger, active patients and manual laborers
Often performed in conjunction with rotator cuff repair or for SLAP tears in adults over 35
RecoveryTenodesis: sling for 4–6 weeks, return to full activity in 3–4 months. Tenotomy alone has a faster recovery: 4–6 weeks for most activities.
Shoulder · Joint Separation
AC Joint Injury (Shoulder Separation)
The acromioclavicular (AC) joint is the small joint at the top of your shoulder where your collarbone meets the shoulder blade. A shoulder separation — not to be confused with a shoulder dislocation — occurs when the ligaments holding this joint together are stretched or torn. It's common in contact sports and after falls. Most AC joint injuries are mild to moderate and heal without surgery.
How It Happens
A direct fall onto the top or tip of the shoulder
Tackle or collision in football, hockey, rugby
Falling off a bicycle onto the shoulder
Graded I–VI based on severity (I = sprain; VI = severe dislocation)
What You'll Feel
Pain and tenderness directly at the top of the shoulder
A visible bump at the top of the shoulder (the clavicle riding up)
Pain with overhead movements and reaching across the body
Difficulty sleeping on the affected side
Treatment Options
Non-Surgical (Grades I–III)
The large majority of AC joint injuries — including Grade III — are treated without surgery
Sling for comfort for 1–3 weeks
Ice, anti-inflammatories, and activity modification
Physical therapy to restore strength and motion
Most patients return to sport in 2–8 weeks depending on grade
Surgical (Grades IV–VI / Failed Grade III)
High-grade injuries or those with persistent pain/instability after conservative care may benefit from surgery
AC joint reconstruction: the ligaments are rebuilt using a graft or fixation device to restore the normal anatomy of the joint
Several techniques exist; the approach is tailored to injury severity and timing
RecoveryGrades I–II: return to sport in 1–3 weeks. Grade III: 4–8 weeks. Surgical reconstruction: 4–6 months before return to contact sport.
Shoulder · Stiffness
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is a painful condition in which the capsule (the soft tissue envelope surrounding the shoulder joint) becomes inflamed and thickens, causing the shoulder to become progressively stiff and painful. It goes through three stages: a painful "freezing" phase, a stiff "frozen" phase, and a gradual "thawing" phase. Without treatment, the entire process can take 1–3 years. With proper treatment, recovery is often much faster.
Who Gets It
Most common in adults aged 40–60
More common in women than men
Often follows a period of shoulder immobilization (after surgery, fracture, or rotator cuff injury)
Strongly associated with diabetes — occurs in up to 20% of people with diabetes
Thyroid disorders and heart disease also increase risk
What You'll Feel
Phase 1 (Freezing — up to 9 months): gradually worsening pain, especially at night; beginning loss of motion
Phase 2 (Frozen — 4–12 months): severe stiffness in all directions; pain may lessen slightly but the shoulder barely moves
Phase 3 (Thawing — 5–24 months): gradual return of motion; pain continues to improve
Treatment Options
Non-Surgical (Primary Treatment)
Physical therapy: gentle stretching and range of motion exercises — the most important intervention
Corticosteroid injections into the joint — most effective in the freezing phase to reduce inflammation and allow PT to work
Hydrodilatation: injecting saline into the joint capsule to stretch it — can provide rapid relief
Anti-inflammatory medications
Patience — this condition resolves with time in most patients
Surgical (Refractory Cases)
Manipulation Under Anesthesia (MUA): While you are asleep, the shoulder is gently forced through its full range of motion to break up the scar tissue — usually followed immediately by a cortisone injection and intensive PT
Arthroscopic Capsular Release: The tightened capsule is cut and released using small instruments — provides more reliable motion restoration in severe or refractory cases
Surgery is reserved for patients who have not improved after 6+ months of conservative treatment
RecoveryNon-surgical: gradual improvement over 6–18 months. After MUA or surgical release: aggressive PT begins the next day, with significant improvement in motion within 6–12 weeks.
Shoulder · Arthritis
Shoulder Osteoarthritis
Shoulder osteoarthritis is the wear and tear of the cartilage in the glenohumeral joint — the ball-and-socket joint of the shoulder. As the cartilage wears away, the smooth gliding of the joint is replaced by bone-on-bone friction, causing pain, stiffness, and loss of motion. While less common than knee or hip arthritis, shoulder arthritis can severely impact quality of life, especially for active adults. When non-surgical options are exhausted, shoulder replacement is a highly effective solution.
Risk Factors
Age — most common after 50
Prior shoulder injuries, fractures, or surgeries
Rotator cuff arthropathy — advanced arthritis from a long-standing large rotator cuff tear
Inflammatory arthritis (rheumatoid arthritis)
Avascular necrosis (loss of blood supply to the humeral head)
What You'll Feel
Deep, aching pain in the shoulder — gradually worsening over months to years
Stiffness — especially in the morning or after rest
Grinding or crunching sensation with movement
Progressive loss of ability to reach overhead or behind the back
Pain at rest and at night in advanced stages
Treatment Options
Non-Surgical
Activity modification to avoid positions that aggravate the joint
Physical therapy for range of motion and strengthening
Anti-inflammatory medications
Corticosteroid injections for periodic flares of pain
Hyaluronic acid ("gel") injections for lubrication
Surgical — Shoulder Replacement
Total Shoulder Replacement (Anatomic TSA): The ball and socket are resurfaced with metal and plastic implants. Excellent for patients with intact rotator cuff muscles. Reliably reduces pain and improves motion
Reverse Total Shoulder Replacement: The ball and socket positions are reversed. Indicated for patients with rotator cuff tear arthropathy or massive irreparable tears. Remarkable outcomes even in challenging cases
Hemiarthroplasty: Only the ball side is replaced — used in specific fracture or AVN cases
Shoulder replacement is one of the most successful operations in orthopaedics — over 95% of patients report significant pain relief
RecoveryAfter shoulder replacement: sling for 4–6 weeks, then PT. Most patients reach their peak function at 6–12 months, with significant pain relief often felt within the first few weeks. Implants typically last 15–20+ years.
Shoulder arthritis does not have to mean a life of pain and limited motion. Dr. McLaughlin specializes in shoulder replacement and will guide you through your options.