Why hasn't my shoulder healed

Shoulder injury typically results in inflammation or tears of tendons which make up rotator cuff. There is often also pain and spasm of muscles surrounding the shoulder and tears of cartilage called labrum.

Most of the time the pain after shoulder injury will resolve in 2 weeks to 2 months, however in about 10-20% of the patients the pain may persist. It is important to understand that although sometimes rotator cuff tears are painful, many are not. Tears are more likely to affect stability and function of the joint than cause pain.

Typically if the pain is constant and severe, it is because the nerve ending in the muscles and shoulder joint become very sensitive and inflamed after the injury and continue to send pain signals even after the tissues have healed. Unfortunately these chemical and electrical changes do not show up on any tests, so it is difficult to determine what percent of the pain is due to anatomical changes one sees on MRI or ultrasound and what percent is due to hypersensitivity of the nervous system. Generally speaking the more widespread the pain is the less likely it is due to anatomical changes such as tears.

To sum up, shoulder injuries are often associated with rotator cuff tears. Because rotator cuff tendons have poor circulation they often do not heal, however that does not mean that pain will necessarily persist. General approaches to pain such as physiotherapy or various injections can lead to resolution of pain without necessarily healing the tears. If one is an athlete or participating in very physically demanding work which requires joint stability, then rotator cuff repair should be considered. Although more controversial, regenerative medicine injections such as PRP, Prolotherapy or mesenchymal stem cell injections can also be used to stimulate healing of damaged tendons.