Orthopedic and Sports Medicine

Shoulder Injuries

Advocare Orthopedic & Sports Medicine Center specializes in conditions and injuries of the shoulder. The shoulder is an integral part of the human anatomy. We understand that limited range of motion, weakness and pain can make it difficult to perform common everyday tasks. The Advocare team is committed to getting you back to your activities as quickly as possible.

The anatomy of the shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The head of the humerus fits into the glenoid (a rounded socket in the scapula). These bones are held in place by muscles, tendons and ligaments. Each component of the shoulder serves an important and vital purpose. The ligaments hold the bones together and create stability, while the tendons connect the muscles to the bones and the muscles make movement possible. 

The most common shoulder injuries do not involve the bones, but instead, involve the muscles, ligaments, and tendons. Since athletes are most susceptible to shoulder problems, many conditions develop slowly, over time, through repetitive and intense training. Some patients have a tendency to ignore the pain and "play through" a shoulder injury. However, this only aggravates the condition causing more problems later. Here we will outline common shoulder injuries and how Advocare Orthopedic & Sports Medicine Center is the best choice for all treatment needs: Shoulder Impingement/Bursitis, Rotator Cuff Tear/Weakness, Shoulder Instability/Labral Tears, Biceps Tendon Tear and AC Joint Separation. 

Shoulder Impingement/Bursitis:

Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed. These conditions are caused by overuse and improper lifting techniques. Symptoms include extreme pain or weakness, especially when performing overhead activities. These conditions often occur in conjunction with each other. 


  • Pain while performing an activity and at rest
  • Pain that radiates from the front of the shoulder to the side of the arm
  • Pain with throwing
  • Pain with overhead motion
  • Sudden pain when lifting/reaching


Depending on the severity of the injury, shoulder impingement or bursitis can be treated non-surgically through rest, cortisone injections and physical therapy, and in some cases requires surgery. Should surgery be required, Dr. Vitolo would perform minimally invasive arthroscopic surgery to repair the injury and would then devise a rehabilitation program to get you back to full activity as quickly as possible. 

Rotator Cuff Tear/Weakness

Rotator cuff weakness and tears can be caused by constant throwing motions or trauma to the shoulder. Weakness occurs when the rotator cuff tendons become inflamed and may rub on the undersurface of part of the shoulder blade. Rotator cuff tears occur when the tendon is ripped off the bone. 


  • Limited motion
  • Decreased shoulder strength
  • Aching and weakness when you lift your arm above your head


Depending on the size and severity of the rotator cuff tear, surgery may or may not be required. If surgery is needed, John Vitolo, MD specializes in the arthroscopic repair of rotator cuff tears. This minimally invasive surgery is performed through a small incision in the shoulder. Dr. Vitolo uses a double repair (consisting of 2 rows of anchors) to reinforce healing and a fast recovery of the rotator cuff. By using this method, Dr. Vitolo has noticed that his patients are experiencing less post-operative pain and are healing faster. For more information: Ortho Info

Labral Tears/Labrum Injuries

Surrounding the outside edge of the glenoid (ball and socket joint) is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.

Labral tears can result from an acute trauma (i.e. falling on an outstretched arm, a sudden pull when lifting or a direct hit to the shoulder) or from repeating the same motion over time (i.e. throwing or lifting). The two common labral tears are a SLAP lesion and a Bankart Lesion. A SLAP lesion is located above the middle of the socket and may also involve the biceps tendon. A Bankart Lesion is below the middle of the Glenoid socket and also involves the glenohumeral ligament. Tears like these often occur in conjunction with other injuries, such as a dislocated shoulder.


  • Pain, usually with overhead activities
  • Pain with throwing
  • Catching, locking, popping, or grinding
  • Occasional night pain or pain with daily activities
  • A sense of instability in the shoulder
  • Decreased range of motion
  • Weakness


Depending on the severity of the injury, some labral injuries may be treated with rest, physical therapy and anti-inflammatory. If surgery is required, rest assured that Dr. Vitolo uses the latest techniques and a time tested devised protocol for faster healing and superior results. At Advocare Orthopedic & Sports Medicine Center, the patient is our first priority. We want you to get back to living pain free as quickly as possible. 

Biceps Tendon Tear 

The upper end of the biceps muscle has two tendons that attach it to bones in the shoulder. The longer tendon attaches to the top of the shoulder socket (glenoid), while the shorter tendon attaches to a bump on the shoulder blade called the coracoid process. The long head of the biceps tendon is more likely to tear. A tear of the biceps tendon can either be partial or complete.

A tear of the biceps tendon can be the result of an acute injury or overuse. Certain factors increase the risk of having a torn biceps tendon, such as age, heavy overhead lifting and overuse of the shoulder. 


  • Sudden, sharp pain in the upper arm
  • Sometimes an audible pop or snap
  • Cramping of the biceps muscle with strenuous use of the arm
  • Bruising from the middle of the upper arm down toward the elbow
  • Pain or tenderness at the shoulder and the elbow
  • Weakness in the shoulder and the elbow
  • Difficulty turning the arm palm up or palm down
  • Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow may appear, with a dent closer to the shoulder


Depending on the size and severity of the tear, non-surgical treatment may be used. A combination of ice, anti-inflammatory medications, rest, and physical therapy would be used to heal the tear. If surgery is needed, Dr. Vitolo would use minimally invasive arthroscopic surgery, followed by physical therapy. The surgery is performed as an out-patient and patients are able to return home the same day. 

Advocare Orthopedic & Sports Medicine Center is committed to evaluating each patient individually and aims to treat injuries with minimally invasive treatments. Surgery is always a last resort. We take pride in our commitment to providing the highest quality care and compassion to each patient we treat.

If you suspect you have a shoulder injury, we encourage you to call and make an appointment today.