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Rotator Cuff Tears

“A common source of shoulder pain that can be treated without surgery”

Shoulder impingement syndrome is the most common disorder of the shoulder. It is often associated with subacromial bursitis, shoulder rotator cuff tear, shoulder tendinitis or tendinosis, and calcified tendonitis. The incidence of shoulder pathology makes up 2.5% of visits to primary care physician, and the prevalence within the U.S. is greater than 25%. Risk factors include deconditioning, neurological injuries, sports involving throwing or overhead activities and trauma.

Why your shoulder hurts.

The shoulder is an amazing structure allowing you to move in many directions. When the intricate muscle balance is disrupted due to repetitive or excessive contact or abrasion of the rotator cuff muscles and tendons the tissues get overloaded causing wear-in-tear. After a while when enough tissue has broken down, you develop shoulder pain eventually resulting in weakness and stiffness. Pathology progresses from edema and hemorrhage to cuff fibrosis and thickening or a partial cuff tear that develops to full thickness tears, tendon ruptures and bony changes.


The symptoms can vary in intensity and frequency. They include:
• Pain along the scapula and is worsened with forward flexion of the shoulder. The pain is often referred to the lateral shoulder and mid arm.
• Difficulty removing your shirt or coat and reaching overhead.
• Atrophy of the shoulder muscles
• Active shoulder range of motion limitations may be related to deltoid or rotator cuff weakness resulting from pain-related disuse atrophy

If you are experiencing pain or weakness in the neck, upper arm, or shoulder you could be suffering from shoulder impingement or a rotator cuff tear. Our expert sports medicine doctors at Spine & Sports Medicine of New York use expertise in innovative assessments to accurately diagnose the cause of your shoulder pain.

Other causes of shoulder pain include: 

• Cervical disc herniations
• Cervical myelopathy of the spinal cord• Cervical spondylosis (arthritis)
• Frozen shoulder
• Glenohumeral instability or osteoarthritis
• Lung tumors
• Nerve damage

Our Board-Certified Physicians Can Accurately Diagnose the Source of Your Pain

We conduct a thorough clinical evaluation to determine if the pain is generated from your shoulder or from a herniated disc in your neck as well as other conditions that share similar symptoms. We begin our evaluation of your problem with a complete medical history using detailed information gathering tools followed by a focused physical examination. We then confirm our diagnosis with specialized tests which may include x-rays, ultrasonography, MRI, CT and electrodiagnostic (EMG) studies.

“No surgery is needed to relieve your shoulder pain”


Often only simple treatments such as a modification of activity, anti-inflammatory medications, rotator cuff strengthening and physical therapy are all that are needed. If minimal progress is noted, then an anesthetic injection into the region of interest in the shoulder can help with diagnosis and treatment. Intra-articular or subacromial corticosteroid and anesthetic injections using ultrasound guidance have been shown to provide short-term relief. Alternately, intra-articular sodium hyaluronate into the glenohumeral joint or bursa using ultrasound guidance have been well tolerated as well without the side effects of steroids. In patients that have not had significant improvement then more advanced procedures are done which include a platelet-rich plasma (PRP) injection to regenerate the damaged tissue.

Here’s what you can expect if one of our specialists treats your pain:

• Relief of pain to get you back to living.
• Several treatment options available to target the root of the problem
• May be accompanied by physical therapy to strengthen the rotator cuff muscles to prevent recurrence
• Body mechanics awareness to eliminate the source of the pain
• Many patients gain considerable to complete relief with innovative procedures
• No general anesthesia or prolonged recovery periods to slow you down from your busy schedule
• Thousands of patients have been helped by our innovative approach to sports medicine


Hawkins RJ, Bilco T, Bonutti P. Cervical spine and shoulder pain. Clin Orthop Relat Res. 1990 Sep;(258):142-6.
Panagos A. Rehabilitation Medicine Quick Reference-Spine (ed. Buschbacher R.M.) New York: Demos Publishing; 2010. p. 200-201.

This coronal shoulder MRI  demonstrates a normal supraspinatus muscle as it attaches to the humerus.

This coronal shoulder MRI
demonstrates a normal supraspinatus muscle as it attaches to the humerus.

get to know more

Dear Dr. Panagos,

Although I haven’t seen you in a while, I wanted to write you a thank you testimonial because my one visit at your office changed my life.

When I met you, you immediately heard me, you suggested based on my past medical history (already having seen a doctor and trying physical therapy etc) to have an MRI rather than waiting and making me come back and forth to the office as many other doctors would have tried.

You then gave me great advice – get a standing desk or you’ll be back for surgery. Your straight talk saved my life in so many ways. In fact,
I’ve provided your sage advice to many others that standing desks are beneficial especially for people with back pan (or not) or work at companies where long hours required.

During our visit, you spent time talking to me about the medical facts and my potential for being a candidate for surgery due to my pain from 3 herniated disks, but that it was not the only option. You offered eating tips some closely related to the Paleo Diet (cut out processed foods, eat more fruits, veges, and protein, avoid bread, gaseous foods in my case, limiting dairy, chocolate, common sense, etc) and other pain relief ideas. Believe it or not, I am one of those A type personalities that listened and tried it.

Soon after I bought a book called Paleo Diet, I adhered to it strictly for the first 30 days then modified as the author suggested, I lost 23 pounds in about 13 months without even trying. Then after many months, I started to resume modified yoga and tennis *sorry just can’t give it up*.

However, the biggest pain relief I had was time and the “standing desk.” Guess I was one of the lucky ones.

Thank you again for helping me and going beyond what was required to help my future and provide me the facts about the surgery, alternatives, and healthy choices. I appreciated your visit and sage advice until we may meet again.

Be well and please feel free to keep in touch.

I also concur with your thoughts that women take calcium and magnesium together, along with their Vitamin D’s.. etc..

All great things you managed to say in 1 doctor’s visit to me. It made me feel special.

You are a great doctor. I never knew there was a cure for “pain” and it was so much about food and managing timing (lots of time).

Elysa D.

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