I am experiencing severe pain in my left shoulder. I have undergone 30 physical therapy sessions and received 7 shoulder block injections, but without improvement. MRI of the left shoulder shows: degeneration of the supraspinatus tendon, subscapularis tendon, and the intra-articular portion of the long head of the biceps brachii tendon. Osteoarthritic changes in the acromioclavicular joint with narrowing of the acromiohumeral space (possible impingement). Subacromial-subdeltoid bursitis. X-ray findings in the soft tissue projection cranial to the greater tubercle of the humerus reveal an oval mineral shadow 4 mm in diameter, characteristic of an intratendinous calcification. Enthesopathy of the greater tubercle of the humerus. Please explain these findings and advise on treatment.

Your findings point to moderate degenerative changes in the soft tissues of the shoulder, particularly in the rotator cuff tendons. This kind of MRI suggests the presence of extreme shoulder movements, with possible mild nighttime pain and discomfort during physical exertion. If the symptoms are significantly more severe than described, especially if they persist after repeated injections and long-term physical therapy, the underlying causes should be investigated beyond what is visible on the MRI and X-ray. This can be done through a detailed physical examination. There are many possible causes, with the following three being the most common in our clinic:

Frozen shoulder (adhesive capsulitis) – Inflammation of the joint capsule leading to the formation of scar tissue. Symptoms can last for years and are characterized by limited mobility and pronounced nighttime pain during the first few months. Typical physical therapy exercises and swimming often aggravate this condition.

Limited mobility of the cervical and thoracic spine, with or without direct nerve compression. Since the shoulder girdle functions as a unit that includes the spine, several joints around the shoulder, and muscles and tendons, reduced mobility in one part can provoke pain in another. Prolonged sitting and shoulder activity in that position can particularly exacerbate the discomfort.

Weakness in the muscles of the interscapular region, with or without scapular dyskinesia. This is typical for physically inactive people whose work involves sitting or standing for extended periods.
Each of these conditions is treated with specific physical therapy procedures.