Shoulder Pain

The shoulder joint is supported by the rotator cuff and made up of the muscles and tendons in your shoulder. These muscles and tendons connect your upper arm bone with your shoulder blade and hold the ball of your upper arm bone firmly in your shoulder socket. This combination results in the greatest range of motion of any joint in your body. A shoulder condition or rotator cuff injury, which is very common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:


Bursitis is a painful condition that affects the small fluid-filled, cushion like pads called bursa. Bursa are cushions that lie between a tendon and a bone to prevent excess friction. Bursitis occurs when a bursa becomes inflamed.

If you have bursitis, the affected joint may:

  • Feel achy or stiff
  • Hurt more when you move it or press on it
  • Look swollen and red
  • Prevent you from elevating your arm or reaching behind

Rotator cuff injury

Rotator cuff injuries occur when one of the 4 main muscles or their tendons  that form the rotator cuff become injured, inflamed, worn down or torn.

If you have a rotator cuff injury, the affected joint may have:

  • Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side
  • Shoulder weakness
  • Loss of shoulder range of motion
  • Inclination to keep your shoulder inactive
  • Inability to raise your arm from your side


Osteoarthritis occurs when the surfaces in the joint begin to wear down.

What Is Osteoarthritis?

The joints of the body are normally surrounded by a fluid that acts as a lubricant and shock absorber. This fluid is lacking in patients with osteoarthritis, and leads to pain and inflammation in the joints.

Osteoarthritis, also known as degenerative joint disease, occurs when the cartilage that covers the tops of bones, known as articular cartilage, degenerates or wears down. The roughened and jagged bone surfaces become inflamedcausingswelling, pain, and sometimes the development of osteophytes (or bone spurs) when the ends of the two bones rub together.

What Is Osteoarthritis of the Shoulder?

The shoulder is made up of two joints, the acromio-clavicular (AC) joint and the glenohumeral joint. The AC joint is the point where the collarbone, or clavicle, meets the acromion, which is the tip of the shoulder blade. The glenohumeral joint is the point where the top of the arm bone, or humerus, meets the shoulder blade, or scapula. Osteoarthritis is more commonly found in the AC joint.

Who Gets Shoulder Osteoarthritis?

Osteoarthritis most often occurs in people who are over the age of 50. In younger people, osteoarthritis can result from an injury or trauma, such as a fractured or dislocated shoulder.Osteoarthritis may also be hereditary.

What Are the Symptoms of Shoulder Osteoarthritis?

As with most osteoarthritis, pain is aprimarysymptom. A person with shoulder arthritis is likely to have pain with activity, certain ranges of motion and at rest due to inflammation-causing difficulty sleeping. Range of motion generally decreases over time.

How Is Shoulder Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.  

X-rays: Plain X-rays can reveal narrowing of the space in the two joints of the shoulder: the AC joint between the collar bone and the tip of the shoulder blade, and the glenohumeral joint between the humerous(the large bone of your arm and the shoulder blade).This reveals wear and tear on the cartilage from arthritis like diseases and bone spurs that can interfere with movement.X-ray reveals changes in the shape of the bones in the shoulder that may press upon tendons of the rotator cuff, restricting movement and causing pain.

MRI: Magnetic Resonance Imaging is a noninvasive procedure that can reveal details of the rotator cuff,the fibrocartilage ring around the head of the humerous called the labrum, show tears andchanges in the tendons called tendinosis, arthritis and bursitis.

Myelography/CT scanning: Sometimes used as an alternative to MRI.

Diagnostic ultrasound Imaging: Unlike an x-ray, which emits radiation and shows only bone, diagnostic ultrasound is non-invasive and allows for viewing the causes of your shoulder joint pain with great accuracy. With musculoskeletal ultrasound imaging (MSUS), the muscles, tendons, ligaments, cartilage and joint can be accurately examined at the time of your visit. This provides immediate information about the health of your joint and what factors are contributing to your pain. With this information at hand, specific treatment options can be established immediately!


When the shoulder joint is painful or damaged there are successful treatment options.

Why are ultrasound-guided injections better and more accurate?

 When using an injection to deliver treatment into painful joints, it is necessary to be exact and precise.

The OptimumJoint Team are highly trained in ultrasound-guided injections. These procedures are performed in the office, at the time of your visit. Some of the common structures involved in joint pain may be as little as 2-3mm wide and therefore require a high level of precision to be accurate. In addition, when performing an injection, there are also structures that you want to avoid so you don’t knick or damage them on your way into the joint. The ultrasound machine provides live imaging in real time, to safely place injectable medications or treatments into or around the joint with laser-like precision.

Consider trying to hit a target blindfolded¾you may know the general direction but would not be certain if you have actually hit your target. With live ultrasound imaging, the targeted areas of pain are viewed in real time while the injection is taking place, guiding the needle with pin-point accuracy.

Cortisone Injection

Painful arthritic joints, chronic tendinitis, bursitis and inflammation respond quickly to cortisone. In many cases this is the head start patients need to allow for gains with more conservative care and no further treatment is required. Many patients think that cortisone is bad for you. Too much of anything is not good. Using cortisone infrequently, as much as several times per year will not do any harm. If the pain continues to return, other treatment options should be considered.

Cortisone is injected using continuous live ultrasound guidance exactly where it is needed to quickly reduce inflammation and pain.

Lubrication for Arthritis:

Why Hyalgan?

A squeaky gear needs the most oil!

The joints of the body are normally surrounded by a lubricant and shock absorber called Synovial fluid. Patients with osteoarthritis experience pain and inflammation because arthritic damage in thejoint causes the Synovial fluid to break down over time.

This process causes increased friction and excess wear and tear on the cartilage cushioning movement that becomes rough and jagged causing the joint further deteriorate. Range of motion, walking, getting up from a seated position, climbing and descending steps and weight bearing is often painful. Pain is often increased during or after activity.

What is Hyalgan?

Hyalgan is a naturally derived lubricant that instantly cushions and lubricates painful arthritic joints. By restoring lubrication and cushion, your joints move more freely again with less friction and most importantly, less pain. Hyalgan is injected using continuous live ultrasound guidance ensuring pin-point accuracy exactly where it is needed.

Platelet Rich Plasma Therapy (PRP): Jump starting the healing signals:

Why use PRP?

When there is shoulder joint damage, rotator cuff tear, tendinosis, chronic bursitis or arthritis this exciting new procedure (made popular by professional athletes) that heals damaged structures in a joint such as the labrum, tendons, muscle, ligament or cartilage is showing exciting results!

How does PRP work?

When you cut your skin and it bleeds, platelets collect and gather at the wound site. Once there, platelets act like a conductor in an orchestra. They release growth factors that signal the healing activities to begin, resulting in a cascade of events that restore the damaged tissue.

Joints, however, do not have a direct blood supply. Therefore, when a joint structure is damaged or torn, platelets do not gather and orchestrate the necessary events for that damage to be restored. Joint damage either heals slowly or not at all. That is where Platelet Rich Plasma Therapy (PRP) proves valuable!


New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasive LIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.


Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped.Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increaselocal circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

When to see a doctor:

You should see your doctor if:

  • You’re experiencing severe shoulder pain
  • You’re unable to use your arm
  • You have shoulder pain that has lasted more than a week
  • You have difficulty raising your arm to or above 90 degrees
  • You experience pain reaching behind your neck or reaching around your back



Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.