General information
Shoulder pain in active adults
Shoulder pain can take away your swing, your serve and your sleep. I start by understanding what you want back, then examine your shoulder and review appropriate imaging so we can discuss your options — not assume you need an operation or an injection.
Common causes
- Rotator cuff irritation or partial- and full-thickness tears
- Shoulder arthritis and stiffness
- Instability, labral injuries and biceps tendon problems
Where our conversation starts
Partial-thickness rotator cuff tears
What we consider first
Many partial tears can be managed without surgery. We look at your symptoms, strength and goals, not just the words in the MRI report.
Other options we review
Activity changes, physician-directed physical therapy and appropriate pain relief usually come first. Injections, selected orthobiologic options or surgery may be discussed if symptoms persist, depending on the tear.
Full-thickness rotator cuff tears
What we consider first
A full-thickness tear with weakness, pain or loss of function may warrant repair. A tear does not automatically mean surgery; timing, tear size, tissue quality and your needs matter.
Other options we review
We discuss the benefits and limitations of physical therapy, medications, injections and repair. Orthobiologics are not a substitute for repairing a tendon when structural repair is needed.
Early shoulder arthritis
What we consider first
We usually begin with activity changes, appropriate pain relief, home exercises and sometimes physical therapy. These may help symptoms but cannot be promised to prevent a future replacement.
Other options we review
We review the short-term benefits and drawbacks of steroid injections and the limits of evidence for orthobiologics. X-rays help us assess joint wear, bone loss and deformity.
Advanced shoulder arthritis
What we consider first
When arthritis affects your sleep and daily function despite reasonable non-operative care, shoulder replacement deserves a thoughtful discussion.
Other options we review
Medications, therapy and selected injections may still help symptoms. Orthobiologics do not restore a bone-on-bone joint; any possible symptom relief is uncertain and may be temporary.
Where care usually starts
- A careful exam, with imaging when appropriate
- Activity changes and appropriate pain relief
- Physician-directed physical therapy or home exercises when suitable
If it isn’t improving
- Review the diagnosis and how symptoms affect your strength, sleep and everyday activity
- Discuss selected injections and orthobiologics after a fair trial of conservative care, including the limits of evidence
- Consider repair, reconstruction or replacement when the confirmed problem and your function call for it
Get seen promptly if you notice
- A new injury with deformity or inability to use the arm
- Sudden or worsening weakness
- Fever, redness or marked swelling
For a medical emergency, call 911.
Read more in the free guide, Shoulder Discomfort and Staying Active, or browse Patient Education and home exercises.
General education only — not medical advice or a diagnosis. Treatment decisions are made together after an examination.