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Tag: shoulder

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , , , , , , , , , ,

Auto Injuries: Understanding the Damage to The Rotator Cuffs

Get informed about auto injuries and rotator cuffs. Explore ways to protect your shoulders after an accident.

Shoulder Pain and Injuries in Motor Vehicle Accidents: A Comprehensive Guide

Introduction

Shoulder injuries are a frequent consequence of motor vehicle accidents (MVAs), often resulting from the sudden and forceful impacts experienced during collisions. These injuries can range from minor sprains to severe conditions like rotator cuff tears, fractures, and nerve damage, significantly impacting daily life. While a sore shoulder might not earn you a starring role in a tragic drama, it can certainly feel like a grim plot twist in your day-to-day routine. Understanding the clinical reasons behind why shoulder pain and injuries are so closely linked to MVAs is essential for effective treatment and recovery. This blog post explores the mechanisms of shoulder injury in MVAs, their role in developing shoulder pain, and their specific impact on the rotator cuff. We also highlight the expertise of Dr. Alexander Jimenez, a distinguished chiropractor and nurse practitioner in El Paso, Texas, who specializes in treating personal injury cases with advanced diagnostic and therapeutic approaches.

Anatomy of the Shoulder

The shoulder is one of the most mobile joints in the human body, allowing for a wide range of movements, such as lifting, rotating, and reaching. This mobility, however, comes at the cost of stability, making the shoulder particularly vulnerable to injury. The shoulder joint comprises three main bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The rotator cuff, a group of four muscles—supraspinatus, infraspinatus, teres minor, and subscapularis—and their tendons stabilize the shoulder joint and facilitate arm movements. These tendons connect the humerus to the scapula, and any damage to them can lead to significant pain and functional impairment. Ligaments, such as those connecting the clavicle to the scapula, also play a crucial role in maintaining joint stability but are susceptible to stretching or tearing during traumatic events like MVAs.

References

Mechanisms of Shoulder Injury in MVAs

Shoulder injuries in MVAs typically result from the sudden and forceful movements experienced during a collision. Several mechanisms contribute to these injuries:

  1. Bracing Against the Steering Wheel: Drivers often instinctively brace themselves by pushing against the steering wheel during a crash, transmitting significant force to the shoulders. This action can overstretch or tear the rotator cuff tendons, especially in rear-end collisions (El Paso Chiropractor Blog, 2016).
  2. Seatbelt Restraint: While seatbelts are lifesaving, they can cause shoulder injuries if improperly positioned or if the impact force is excessive, leading to bruising, sprains, or fractures.
  3. Direct Impact: In side-impact or rollover accidents, the shoulder may strike the vehicle’s interior, such as the door or window, resulting in fractures or dislocations.
  4. Whiplash Effect: The rapid back-and-forth motion of the neck and upper body, commonly associated with whiplash, can strain shoulder muscles and ligaments, contributing to rotator cuff injuries.

These mechanisms highlight the shoulder’s vulnerability due to its complex structure and the intense forces involved in MVAs.

References

Chiropractic Care After Accidents and Injuries- Video

Common Shoulder Injuries from MVAs

Shoulder injuries from MVAs vary in severity, but the following are among the most common:

Injury TypeDescriptionSymptoms
Rotator Cuff TearsTears in one or more of the rotator cuff tendons, often due to overstretching or direct trauma. Common in rear-end collisions.Radiating pain, restricted mobility, inflammation, swelling, popping/clicking, weakness.
Shoulder Sprains/StrainsStretching or tearing of ligaments (sprains) or muscles (strains) around the shoulder joint.Pain, instability, weakness, swelling.
Fractures/DislocationsBreaks in the clavicle, scapula, or humerus, or dislocation of the shoulder joint due to impact.Severe pain, swelling, bruising, limited movement.
Brachial Plexus InjuriesDamage to the nerve network supplying the shoulder, arm, and hand, often from forceful impact.Numbness, weakness, burning pain, or paralysis in severe cases.

Research suggests that shoulder injuries occur in approximately 27.9% of polytraumatized patients involved in MVAs, with 68.5% of these injuries attributed to traffic accidents, particularly motorbike, bicycle, and pedestrian incidents (TraumaRegister DGU®, n.d.). Additionally, over 2 million Americans experience whiplash injuries annually, many of which involve shoulder pain due to associated muscle and ligament strain (Atlanta Advocate, 2024).

References

Clinical Presentation and Diagnosis

Individuals with shoulder injuries from MVAs may experience a range of symptoms, including:

  • Pain: Often severe, especially with movement, and may radiate to the arm or upper back.
  • Limited Range of Motion: Difficulty lifting or rotating the arm.
  • Swelling or Bruising: Visible signs of trauma around the shoulder.
  • Weakness: Reduced strength in the arm, particularly with rotator cuff tears.
  • Numbness or Tingling: Indicative of nerve involvement, such as brachial plexus injuries.

Diagnosis involves a thorough clinical evaluation, including a detailed medical history and physical examination to assess pain, range of motion, and strength. Advanced imaging techniques, such as X-rays, MRIs, or CT scans, are often used to confirm the extent of damage. Dr. Alexander Jimenez, with his dual expertise as a chiropractor and a board-certified nurse practitioner, utilizes these diagnostic tools to identify shoulder injuries accurately. His approach integrates biomechanical assessments with medical diagnostics, ensuring a comprehensive understanding of the injury’s scope (A4M, n.d.).

References

Treatment and Rehabilitation

Treatment for shoulder injuries from MVAs depends on the injury’s severity and type. Conservative approaches are often the first line of treatment and include:

  • Chiropractic Care: Spinal adjustments and soft tissue manipulations to restore alignment and reduce pain.
  • Physical Therapy: Targeted exercises to strengthen the rotator cuff, improve flexibility, and restore function.
  • Pain Management: Medications, acupuncture, or massage therapy to alleviate pain and inflammation.

For severe injuries, such as complete rotator cuff tears or complex fractures, surgical intervention may be necessary. Rehabilitation is critical, focusing on restoring strength and mobility and preventing chronic pain. Dr. Jimenez’s clinic emphasizes personalized rehabilitation plans, incorporating functional medicine to address underlying factors like inflammation or nutritional deficiencies (El Paso Back Clinic, 2025). Ligament injuries, common in shoulder trauma, heal through phases of inflammation, proliferation, and remodeling, but scar tissue may remain biomechanically inferior, necessitating careful rehabilitation to avoid long-term joint laxity.

References

Role of Chiropractic Care in Shoulder Injury Recovery

Chiropractic care is a cornerstone of recovery for MVA-related shoulder injuries. Dr. Jimenez employs hands-on techniques, including spinal and joint manipulations, to address misalignments and alleviate pain. These adjustments improve joint mobility, relieve pressure on nerves, and enhance healing. His integrative approach combines chiropractic care with physical therapy, acupuncture, and nutritional counseling to promote holistic recovery. For instance, chiropractic adjustments can help realign the shoulder joint, while targeted exercises strengthen the rotator cuff, preventing future injuries. Dr. Jimenez’s dual licensure enables him to bridge chiropractic and medical care, providing a comprehensive treatment plan tailored to each patient’s specific needs (A4M, n.d.).

References

Personal Injury Cases and Legal Aspects

In El Paso, Texas, personal injury cases related to MVAs are significant, as victims often seek compensation for medical expenses, lost wages, and pain and suffering. Accurate documentation of injuries is crucial for these claims. Dr. Jimenez plays a pivotal role as a liaison between medical and legal services, providing detailed medical reports supported by advanced imaging and diagnostic evaluations. His expertise ensures that injuries are clinically linked to the accident, thereby strengthening legal claims. This dual role enhances patient care while supporting their pursuit of fair compensation (El Paso Back Clinic, 2025).

References

Conclusion

Shoulder injuries from motor vehicle accidents, particularly rotator cuff tears, are a significant concern due to the shoulder’s complex anatomy and the intense forces involved in collisions. Research suggests that these injuries are common, with traffic accidents accounting for a substantial portion of shoulder trauma in polytraumatized patients. Dr. Alexander Jimenez’s integrative approach, combining chiropractic care, advanced diagnostics, and personalized rehabilitation, offers a comprehensive recovery solution. His role in personal injury cases in El Paso underscores the importance of expert medical care in both healing and legal documentation. If you or a loved one has suffered a shoulder injury in an MVA, consulting a specialist like Dr. Jimenez can ensure optimal recovery and support for any legal claims.

Disclaimer: This blog post is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.

References

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Athletes, Sporting , , , , , , , , , , , , , , , ,

The Throwing Motion and Its Impact on Performance

Can understanding the mechanics of the throwing motion help to understand why it may cause shoulder pain, the symptoms of a shoulder problem, the diagnosis, and the treatment options available?

Throwing a Ball and Shoulder Pain

The throwing motion is a complex shoulder movement that requires the mechanics of muscles, tendons, joints, ligaments, and bones. They all must move in a synchronized and stable pattern to move the shoulder joint. When these mechanics are interrupted or altered, inflammation can result in pain symptoms. (Wardell M., Creighton D., & Kovalcik C., 2022)

Throwing Motion

Distinct phases characterize the throwing motion:

  • The wind up
  • Cocking
  • Acceleration
  • Follow-through
  • Deceleration
  1. The rotator cuff and shoulder muscles sequentially guide the movements for effective throwing mechanics. (Wardell M., Creighton D., & Kovalcik C., 2022)
  2. The labrum stabilizes the ball in the socket of the shoulder.
  3. The shoulder blade rotation coordinates with the arm to ensure mobility. (Itoigawa Y. et al., 2023)

The throwing motion generates high torque and acceleration forces acting on the shoulder joint and the surrounding muscles, ligaments, and tendons.

Causes of Pain

Pain when throwing can come from the:

  • Shoulder blade
  • Shoulder joint – cartilage and labrum
  • Rotator cuff muscles and tendons
  • Nerves that control the muscles’ function 

The shoulder blade is attached to the upper back by ligaments, muscles, and tendons. The various muscles and tendons that control the movement of the shoulder blade impact movements. Abnormalities of any area can lead to shoulder dysfunction and pain when throwing. (Wardell M., Creighton D., & Kovalcik C., 2022) The most common is the tightness of the posterior shoulder capsule, causing a loss of normal internal rotation of the shoulder. If this is causing pain, individuals may notice that they can’t reach up as high on the side with the painful shoulder when reaching behind their back.

Symptoms

Whether an athlete or playing catch in the backyard, shoulder function abnormalities can cause significant pain. Some symptoms include.

Aching Pain

  • Often deep in the shoulder or extending down the upper arm.

Dead Arm

  • Lack of strength in the throwing motion.

Pain at Night

  • Pain can awaken you from sleep.

Diagnosis

Finding a healthcare provider familiar with sports injuries can be helpful. They can best determine if a structural abnormality needs to be addressed. (American Academy of Orthopaedic Surgeons, 2021)

Treatment

Most can improve with nonsurgical treatments. The earliest phase of treatment is resting the joint and reducing inflammation. Treatments can include:

  • Ice
  • Anti-inflammatory medications
  • Cortisone injection

Once the inflammation has subsided, the source of the discomfort can be addressed.

Physical Therapy

Therapy can include:

  • A structured shoulder stretching and strengthening program will help.
  • The physical therapist will focus on scapular mobility when managing shoulder joint problems.

Exercises may include: (American Academy of Orthopaedic Surgeons, 2024)

  • Stretching to improve internal rotation or any other lost motion can help allow a more normal throwing motion.
  • Strength exercises are often aimed at the rotator cuff, as these muscles initiate proper shoulder movements and stabilize the shoulder joint.
  • Maintaining flexibility and strength of the periscapular muscles (muscles that attach to the scapula bone) is important to ensure that the scapular movements are coordinated with the throwing motion.

Suppose improvements are not made within three months of therapy, or individuals can’t return to competitive sports within six months. In that case, the individual may need to return to their healthcare provider or see an orthopedic specialist who may recommend surgery. (American Academy of Orthopaedic Surgeons, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions.

  • Wellness & Nutrition: Personalized plans to optimize health and prevent disease.
  • Chronic Pain Management: Non-invasive solutions for fibromyalgia, sciatica, and low back pain.
  • Personal Injury & Auto Accident Care: Tailored rehabilitation for whiplash, soft tissue injuries, and more.
  • Sports Injuries & Orthopedic Care: Treatment for sprains, strains, and complex injuries.
  • Functional Medicine: Root-cause analysis for chronic disorders, incorporating nutrition, lifestyle, and environmental factors.
  • Neuromusculoskeletal Health: Care for neck pain, migraines, herniated discs, and scoliosis.

Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges.

At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Lumbar Spine Injuries in Sports: Chiropractic Healing

References

Wardell, M., Creighton, D., & Kovalcik, C. (2022). Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study. International journal of sports physical therapy, 17(7), 1351–1357. https://doi.org/10.26603/001c.39800

Itoigawa, Y., Koga, A., Morikawa, D., Kubota, A., Uehara, H., Maruyama, Y., Takazawa, Y., & Ishijima, M. (2023). Posterior shoulder stiffness was associated with shoulder pain during throwing in college baseball players: assessment of shear wave elastography. European journal of orthopaedic surgery & traumatology: orthopedie traumatologie, 33(4), 1237–1244. https://doi.org/10.1007/s00590-022-03286-z

American Academy of Orthopaedic Surgeons. (2021). Shoulder Injuries in the Throwing Athlete. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-injuries-in-the-throwing-athlete/

American Academy of Orthopaedic Surgeons. (2024). Shoulder Impingement/Rotator Cuff Tendinitis. https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Exercises, Therapy , , , , , , , , , , , , , , , , , ,

Pectoralis Minor: Understanding Its Role in Posture

For individuals dealing with posture problems causing neck, back, and shoulder pain, can pectoralis minor stretches designed to work these areas be a part of physical therapy or as regular exercises at home?

Pectoralis Minor Muscle Stretches

The pectoralis minor is a small, triangular muscle situated deep to the pectoralis major in the anterior chest wall. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction and connects to the coracoid process of the scapula. The pectoralis minor helps with posture, mobility, and shoulder stability and aids breathing. Muscle tightness can cause pain in the chest, shoulder, and neck and a restricted range of motion. Strain and injuries can occur during activities involving overhead movements or forceful pushing. Pectoralis minor stretches are designed to work these muscles that span the ribs and connect to the shoulder to help improve posture and relieve pain and chest weakness. They can help reduce muscle tightness and other conditions like thoracic outlet syndrome. (Kaur U. et al., 2023) (Wagner E. R. et al., 2023) Talk with a healthcare provider Before starting any exercise or stretching program.

Corner Pectoralis Stretch

A corner pec stretch is similar to a wall push-up, except the emphasis is on staying in a position that lengthens the chest muscles. It’s important to move the whole body as a unit and not bend.

  • Stand facing a corner with a relaxed, upright posture.
  • Place your feet so they are parallel, and bend your knees slightly.
  • Stay as relaxed as possible during the movement to protect your joints.
  • Keep your gaze forward.
  • Place your forearms and palms over the walls where two walls connect at a right angle.
  • With your elbows bent to 90 degrees, move forward into the corner of the wall until you feel a comfortable stretch in the pectorals.
  • Keep the hips straight.
  • Hold the position for up to 30 seconds.
  • Return to starting position.
  • If you need a deeper stretch, move the arm position up or down. (University of North Carolina School of Medicine, 2020)

Doorway Stretch

The doorway stretch is similar to the corner stretch. It works the pectoralis major and the minor muscles and helps with mobility. To perform: (Maryland Pain & Wellness Center, 2025)

  • Stand in a doorway with your feet placed together.
  • Place the palms and forearms on either side of the doorway.
  • Your elbows should be even with your shoulders and bend at a 90-degree angle.
  • Keep your back straight.
  • Take a step forward, leaning into the doorway.
  • You should feel the stretch in the muscle.
  • Repeat the stretch with the other foot.

Exercise and ergonomic changes to your chair or desk height can help improve posture and relieve muscle tightness. (Kaur U. et al., 2023)

T Stretch

The T stretch stretches the front of the chest and is done on the floor, typically with a foam roller placed directly under the spine. To perform: (OrthoCarolina, N.D.)

  • Lie down on your back with the foam roller aligned to the spine.
  • Make sure your head and tailbone are supported.
  • Open your arms straight out like a T.
  • Hold the position while stretching.

Y Stretch

The Y stretch is similar to the T stretch; both reduce chest muscle tightness and discomfort. To perform: (OrthoCarolina, N.D.)

  • Use the same foam roll position, lying on your back with the head and tailbone supported and aligned.
  • Stretch the arms out above your head, placing them into the shape of a Y.
  • Allow the chest muscles that connect to the arms to relax.

Studies have examined how quickly a prone scapular retraction can help stretch the back and shoulders. Results suggest the exercises must be performed longer before the pectoralis minor is lengthened to improve symptoms. (Dye J., Allyn M., & Frank C. 2024) However, further research is needed.

Health Conditions

Pectoralis minor stretches may be part of a personalized therapy program to improve mobility, posture, and/or breathing and sleep quality with health conditions that include:

Stretching and strengthening exercises can help improve their flexibility and function. Exercises can improve strength and function by standing or lying down, depending on the stretch.

Injury Medical Chiropractic and Functional Medicine Clinic

The pectoralis minor muscles are often overlooked in clinical examinations but can contribute to musculoskeletal pain and dysfunction. A healthcare provider can teach about stretches, how they can help, and whether they are safe for the individual’s injury and/or condition. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Doorway Stretching Routine

References

Kaur, U., Shrestha, D., Hussain, M. A., Dalal, P., Kalita, M., Sharma, V., & Sharma, S. (2023). Prompt Impact of Muscle Energy Technique on Pectoralis Muscle Tightness in Computer Users: A Quasi-Experimental Study. Journal of Lifestyle Medicine, 13(2), 123–128. https://doi.org/10.15280/jlm.2023.13.2.123

Wagner, E. R., Gottschalk, M. B., Ahmed, A. S., Graf, A. R., & Karzon, A. L. (2023). Novel Diagnostic and Treatment Techniques for Neurogenic Thoracic Outlet Syndrome. Techniques in hand & upper extremity surgery, 27(2), 100–114. https://doi.org/10.1097/BTH.0000000000000419

University of North Carolina School of Medicine. (2020). Upper Body Stretching. https://www.med.unc.edu/htcenter/wp-content/uploads/sites/711/2020/04/Upper-Body-Stretching.pdf

Maryland Pain & Wellness Center. (2025). Stretches to Help with Strained Chest Muscles. Maryland Pain & Wellness Center Restoring Hope, Rebuilding Lives. https://www.marylandpainandwellnesscenter.com/blog/stretches-to-help-with-strained-chest muscles#:~:text=With%20your%20knees%20bent%20and,assist%20in%20deepening%20the%20stretch.

OrthoCarolina. (N.D.). Stretching Guide to Ease Tight Muscles. https://www.orthocarolina.com/storage/wysiwyg/stretching_guide_1.pdf

Dye, J., Allyn, M., & Frank, C. (2024). Is there an immediate effect on pectoralis minor length after performing a prone scapular retraction exercise using typical sets and repetitions in pain-free participants? Journal of bodywork and movement therapies, 40, 1014–1019. https://doi.org/10.1016/j.jbmt.2024.07.026

Chankavee, N., Amatachaya, S., Hunsawong, T., Thaweewannakij, T., & Mato, L. (2023). Effects of modified long stick exercise on hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis. Journal of back and musculoskeletal rehabilitation, 36(5), 1151–1162. https://doi.org/10.3233/BMR-220350

Liao, Y. X., Saiken, A., Chang, X., Guo, Y. F., Tan, Z., Deng, F., Meng, Q. L., Zhen, H., Li, Y. M., & Fang, B. M. (2025). Associations of fat, bone, and muscle indices with disease severity in patients with obstructive sleep apnea-hypopnea syndrome. Sleep & breathing = Schlaf & Atmung, 29(1), 82. https://doi.org/10.1007/s11325-024-03241-8

Thongchote, K., Chinwaro, U., & Lapmanee, S. (2024). Effects of scapulothoracic exercises on chest mobility, respiratory muscle strength, and pulmonary function in male COPD patients with forward shoulder posture: A randomized controlled trial. F1000Research, 11, 1284. https://doi.org/10.12688/f1000research.126832.2

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Therapy , , , , , , , , , , , , , , , , , ,

The Prevalence of Rotator Cuff Tears and Treatment Approaches

Could older individuals who do not have symptoms of shoulder pain or loss of shoulder and arm function have a rotator cuff tear?

Rotator Cuff Tear Physical Therapy

A rotator cuff tear is a common injury to the four muscles and tendons surrounding and stabilizing the shoulder joint. Studies have shown that (Geary M. B., & Elfar J. C. 2015)

  • 30% of those under the age of 70
  • 70% of those over age 80 have a rotator cuff tear. 

Physical therapy is often recommended as a first-line initial treatment for rotator cuff pain. In most cases, a rotator cuff tear will not need surgical treatment. Determining when surgery is necessary depends on several factors a patient can discuss with their healthcare provider.

Causes

  • Overuse and repetitive motions
  • Trauma (e.g., falls, collisions)
  • Age-related degeneration

Symptoms

  • Shoulder pain, especially with overhead or rotational movements
  • Weakness and difficulty raising the arm
  • Clicking or grinding sounds in the shoulder
  • Limited range of motion

Treatment

The goal of physical therapy for a rotator cuff tear is not necessarily to heal the torn tendon but to relieve pain and improve strength by reducing inflammation and restoring shoulder joint mechanics. This is achieved through physical therapy, ice application, anti-inflammatory treatments like medications, and cortisone injections.

Physical Therapy

The goal of physical therapy is to improve the function of the muscles that surround the shoulder. Physical therapy targets the smaller muscles around the shoulder that are commonly neglected. By strengthening these muscles, the treatment can help compensate for damaged tendons and improve the mechanics of the shoulder joint. A chiropractic physical therapy team will develop a personalized exercise program. Generally, rehabilitation will start with gentle range of motion exercises that can be accomplished using the arms to lift a mobility stick/wand overhead.

Shoulder Pulleys

  • These improve shoulder range of motion and flexibility.

Isometric Exercises

  • These exercises are for the rotator cuff muscles and may then be started.
  • This exercise can improve the contracting of the muscles around the shoulder and offer more support to the shoulder joint.

Scapular Stabilization Exercises

  • These can also be done to improve the muscles surrounding the shoulder blade’s function.
  • This can help improve how the shoulder joint, arm, and scapulae move together when using the arm.

Advanced Strengthening

  • Advanced exercises can be done with a dumbbell or resistance band.

Consult your healthcare provider or physical therapist before starting these or any other exercises for a rotator cuff tear. Doing exercises correctly prevents further pain, injury, or shoulder problems. Specific, focused exercises can help expedite and regain normal shoulder function.

Injury Medical Chiropractic and Functional Medicine Clinic

The prognosis for rotator cuff tears depends on the severity of the tear and the individual’s overall health. With proper treatment, most people can regain the full function of their shoulders. However, some may experience ongoing pain or limitations in severe cases. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Shoulder Pain Chiropractic Treatment

References

Geary, M. B., & Elfar, J. C. (2015). Rotator Cuff Tears in the Elderly Patients. Geriatric orthopaedic surgery & rehabilitation, 6(3), 220–224. https://doi.org/10.1177/2151458515583895

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Work Injury , , , , , , , , , , , , , , , ,

A Closer Look at the Different Stages of Frozen Shoulder

For individuals with shoulder pain and problems, what are the stages of a frozen shoulder, how long do they last, and what can be done to relieve pain?

Frozen Shoulder Stages

A frozen shoulder, also called adhesive capsulitis, is a very common cause of shoulder pain. It causes severe pain and limited mobility. The condition progresses through stages and can take up to two years to resolve completely. The stages of frozen shoulder include pre-freezing, freezing, freezing, and thawing.

Stage 1

Pre-Freezing – 1 month to 3 months

Pre-freezing describes the earliest stage of a frozen shoulder. This is when individuals first start to notice pain in their shoulder. (Soussahn, S. et al., 2024) Many in this stage will first experience the pain at night while changing sleeping positions. As the condition progresses, individuals may notice pain when they move their shoulders, especially when raising their arms or reaching behind them. Individuals may also find reduced mobility in that shoulder and may ache even when not using it. Because motion may be only slightly restricted in this stage, an early frozen shoulder can be mistaken for a rotator cuff problem. (Chan H. B. Y., Pua P. Y., & How C. H. 2017)

Root Cause

A frozen shoulder happens when there is inflammation in the tissue that surrounds the shoulder joint. Although the specific causes aren’t known, immobilization after an injury and other shoulder conditions, like bursitis, may play a role. (Johns Hopkins Medicine, 2025)

Stage 2

Freezing – 10 weeks to 8 months

The freezing stage is the most painful. The shoulder capsule becomes inflamed and can thicken and stiffen. As this happens, shoulder movements become increasingly difficult and painful. (Soussahn, S. et al., 2024)

Stage 3

Frozen – 4 months to 12 months

The third stage of a frozen shoulder is known as the frozen phase, where the shoulder is stiff. The examination finding confirming the frozen shoulder diagnosis is that neither the individual nor another person can move the shoulder. (UpToDate, 2024) With a rotator cuff issue, a patient cannot move their arm normally, but the healthcare provider can. This distinguishes between a frozen shoulder and a rotator cuff injury. The frozen stage is typically much less painful than freezing, but pain can result from simple activities. (Soussahn, S. et al., 2024) Rotation of the shoulder joint is limited, making activities like washing hair or reaching painful or difficult.

Stage 4

Thawing – 5 months to 2 years

In this phase, the shoulder joint capsule becomes thickened and stiff but gradually loosens with time. (Soussahn, S. et al., 2024) Stretching the shoulder capsule, even allowing for some discomfort, is important to ensure the shoulder joint’s mobility continues to recover. Not having the extreme pain associated with freezing the joint and seeing gradual gains in mobility make this stage tolerable.

Treatment

Frozen shoulder treatment starts with physical therapy and joint stretching. Anti-inflammatory medications, ice and heat application, and alternative therapies can all help manage the discomfort. A healthcare provider may also recommend a corticosteroid injection to reduce inflammation, relieve pain, and expedite improved mobility. Redler L. H. & Dennis E. R. 2019)

Surgery is seldom needed but is an option for treating a frozen shoulder. It is usually only considered if prolonged efforts at therapy have failed to improve symptoms. One of the problems is that surgery could worsen shoulder problems. (Le H. V., Lee S. J., Nazarian A., & Rodriguez E. K. 2017)

Prognosis

The timeline for recovery can be long, measured in months and possibly years. (Le H. V., Lee S. J., Nazarian A., & Rodriguez E. K. 2017) Expecting a quick recovery can cause more frustration. However, individuals can take steps to speed their recovery and reduce discomfort. Physical therapy can be beneficial, and a healthcare provider can suggest treatments to help alleviate pain while recovering. Over time, almost all patients will find complete relief and a normal or near-normal range of motion in their shoulder joints.

Injury Medical Chiropractic and Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Motion Key To Healing

References

Soussahn, S., Hu, D., Durieux, J., Kosmas, C., & Faraji, N. (2024). Adhesive capsulitis: Utility of magnetic resonance imaging as a primary diagnostic tool and clinical management support. Current problems in diagnostic radiology, 53(4), 464–469. https://doi.org/10.1067/j.cpradiol.2024.03.005

Chan, H. B. Y., Pua, P. Y., & How, C. H. (2017). Physical therapy in the management of frozen shoulder. Singapore Medical Journal, 58(12), 685–689. https://doi.org/10.11622/smedj.2017107

Johns Hopkins Medicine. (2025). Frozen shoulder. https://www.hopkinsmedicine.org/health/conditions-and-diseases/frozen-shoulder

UpToDate. (2024). Patient education: Frozen shoulder (beyond the basics). https://www.uptodate.com/contents/frozen-shoulder-beyond-the-basics

Redler, L. H., & Dennis, E. R. (2019). Treatment of Adhesive Capsulitis of the Shoulder. The Journal of the American Academy of Orthopaedic Surgeons, 27(12), e544–e554. https://doi.org/10.5435/JAAOS-D-17-00606

Le, H. V., Lee, S. J., Nazarian, A., & Rodriguez, E. K. (2017). Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder & elbow, 9(2), 75–84. https://doi.org/10.1177/1758573216676786

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care , , , , , , , , , , , , , , , , , ,

The Importance of the Long Thoracic Nerve in Shoulder Function

Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?

Long Thoracic Nerve

Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.

Anatomy

The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.

Function

The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)

Susceptibility to Injury

The LTN is relatively unprotected and can be damaged by several things, including:

  • Heavy backpacks
  • Sports
  • Activities the body is not used to, like digging
  • Using crutches

Conditions

Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)

  • Axillary lymph node dissection
  • Improperly placed intercostal drains
  • Chest tube placements
  • Mastectomy
  • Thoracotomy

The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.

The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.

Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:

  • Stand about two feet from a wall, facing it.
  • Place both hands on the wall and gently push against it.
  • If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
  • Have a family member or friend stand behind you and check the shoulder blade position.
  • If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.

Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.

Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.

Treatment and Rehabilitation

Treatment for LTN pain and reduced movement may include:

  • Rest
  • Heat or ice
  • Anti-inflammatory pain medication
  • Neck support or a pillow
  • Avoiding strenuous activity and driving

If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)

  • One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
  • Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
  • After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
  • After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
  • Full shoulder motion and strength recovery are expected six to 12 months after surgery.

Physical therapy may be used to help improve serratus anterior functions. (Berthold J. B., Burg T. M., & Nussbaum R. P. 2017) Exercises to strengthen serratus function may include:

Supine Punches

  • Lie on your back and raise both arms toward the ceiling.
  • Make a fist and punch up toward the ceiling.
  • Ensure the motion is steady and deliberate, and keep the elbow straight.
  • Hold the position for three seconds, then slowly lower the arm to the starting position.
  • Perform 10 to 15 repetitions.
  • Holding a small dumbbell in your hands can make the exercise more challenging.

Pushup

  • Lie on your stomach and place your hands flat on the ground by your shoulders as if you were going to perform a pushup.
  • Perform a pushup and press further, allowing the shoulder blades to wrap around the thorax.
  • Hold this position for three seconds, and slowly release.
  • Perform 10 to 15 reps.
  • If this is too difficult, perform the pushup against a wall to reduce the effect of gravity on the exercise.

Scapular Winging in Depth

References

Waxenbaum, J. A., Reddy, V., & Bordoni, B. (2024). Anatomy, Head and Neck: Cervical Nerves. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844163

Lung, K., St Lucia, K., & Lui, F. (2024). Anatomy, Thorax, Serratus Anterior Muscles. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30285352

Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. https://doi.org/10.7759/cureus.1923

Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. https://doi.org/10.7556/jaoa.2017.025