How He Found Us

He had been dealing with right shoulder pain for about eight months before he came in. A recreational golfer, late 50s, playing three to four times a week. The pain had started after a particularly heavy range session and had gradually gotten bad enough that he was limiting his round count and had lost significant distance off the tee.

His orthopedic workup had confirmed a partial-thickness rotator cuff tear: specifically the supraspinatus. Surgery had been presented as an option but not urgently recommended. He had done six weeks of physical therapy through a standard outpatient clinic with modest improvement, then plateaued. He was not getting worse, but he was not getting better either, and the idea of giving up golf indefinitely was not acceptable to him.

He came to us after reading about shockwave therapy and asking whether it could help a rotator cuff tear. Here is what I told him.

Why Partial Tears Respond to Conservative Care

A partial-thickness rotator cuff tear sits in a clinical gray zone. It is not a full-thickness tear requiring surgical reattachment, but it is more than a mild strain. The tissue has structural damage, and the surrounding muscles and tendons are frequently involved in a broader pattern of tendinopathy, impingement, and compensatory overload.

This is exactly the kind of case where combining multiple conservative modalities, rather than relying on a single approach, produces the best outcomes. His six weeks of PT alone had addressed the movement patterns reasonably well but had not touched the underlying tissue quality or the chronic pain sensitization that had developed over eight months of unresolved pain.

The Three-Part Approach

Shockwave Therapy

We used shockwave therapy directly to the supraspinatus insertion and the surrounding musculature. For partial rotator cuff tears and the associated tendinopathy, shockwave is particularly effective at breaking up degenerative tissue, increasing local vascularization, and restarting the healing cascade. It is one of the few conservative tools that can directly address the structural pathology in the tendon rather than just managing symptoms around it.

He completed six sessions of shockwave over three weeks. By session four, he reported his baseline pain had dropped from a 6 to a 2 to 3. More importantly, his pain during the follow-through portion of his swing, which had been the most limiting factor, decreased significantly.

Dry Needling

Alongside shockwave, we used dry needling to address the trigger point activity in the infraspinatus, subscapularis, and posterior deltoid that had developed as the shoulder guarded against pain over eight months. These muscles do not show up on an MRI as pathological, but they are doing a tremendous amount of compensatory work when the supraspinatus is not functioning correctly, and they become significant pain generators in their own right.

Dry needling involves inserting a thin filiform needle directly into the trigger point, eliciting a local twitch response, and restoring normal muscle function. It is not acupuncture, the mechanism and target are entirely different. For this patient, two sessions of dry needling to the posterior shoulder and upper trapezius reduced his referred shoulder and neck pain by about 70 percent.

Targeted Rehab

The rehab component built on what he had already done in PT and progressed it into golf-specific loading. The rotator cuff’s primary role in the golf swing is stabilizing the humeral head in the socket during rotation, particularly during the transition from backswing to downswing. We rebuilt that stabilizer function using cable rotation patterns, external rotation progressions, and eventually full swing simulation with deliberate loading of the end-range positions that had been painful.

The Outcome

At twelve weeks, he was back to four rounds a week. His distance was within 10 yards of where it had been before the injury and improving. He had gone from seriously considering surgery to genuinely not thinking about his shoulder during his round.

He did not need a different diagnosis or a surgical intervention. He needed the right combination of tools applied in the right sequence. That is what we do.

Is This Combination Right for Your Shoulder?

If you have been dealing with shoulder pain, rotator cuff, calcific tendinitis, chronic impingement, or any shoulder condition that has not fully resolved with one approach, come in for an assessment. We will identify exactly what is happening structurally and give you an honest picture of what conservative care can accomplish before you consider anything more invasive.

 

In your corner,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment