Your Shoulder Pain May Not Be What You've Been Told.

Why MRIs, injections, and even surgery recommendations sometimes miss the real source of shoulder pain.

Author

Dr. Tammy Penhollow
July 21, 2026

Most people assume shoulder pain should be straightforward.

You get an MRI.

The MRI finds a rotator cuff tear.

The treatment plan practically writes itself.

Unfortunately, shoulders do not work that way.

One of the most common things I see in my office is a patient who has already had physical therapy, one or more injections, and sometimes even a surgical recommendation, yet the pain is still there.

The problem often isn't that treatment failed.

The problem is that the shoulder was never fully explained.

“The shoulder is not just a joint. It’s a whole functional unit. If you only treat the structure named in the MRI, you may miss the reason the shoulder hurts in the first place.”  - Tammy Penhollow, DO

That does not mean MRI findings are unimportant.

It does not mean rotator cuff tears do not matter.

And it certainly does not mean surgery is never appropriate.

It simply means that pain is often more complicated than a single imaging finding.

The shoulder is one of the most interconnected regions of the body. The rotator cuff, biceps tendon, AC joint, glenohumeral joint, shoulder blade, neck, ribs, and surrounding muscles all work together. Problems in one area frequently affect another.

That is why lasting improvement often requires us to ask a better question.

Not:
"What did my MRI show?"

But:
"What is actually generating my pain?"

Prefer Video?

If you prefer to learn by video, I recently discussed why shoulder pain can persist despite treatment and why imaging alone does not always tell the whole story.

In this episode, we talk about:
• why some rotator cuff tears are incidental findings
• how neck problems can masquerade as shoulder pain
• why certain injections fail even when they are technically well performed
• and why treating the correct structure matters.

Supporting Recovery at the Cellular Level

One lesson that applies to nearly every area of medicine is that tissues recover best in a healthy environment.

Sleep matters.
Movement matters.
Nutrition matters.
Inflammation matters.

One lesson that applies to nearly every musculoskeletal condition is that tissues recover best in a healthy environment.

If you’re not already using a structured approach, I’ve created a Fullscript dispensary with formulations I trust and use in practice.

Featured Resource:

Nordic Naturals ProOmega 2000

Inflammation is a normal part of healing. The problem occurs when the body struggles to appropriately regulate that response over time.

Omega-3 fatty acids have been studied for their role in supporting cardiovascular health, metabolic health, and inflammatory balance throughout the body.

No supplement replaces a proper diagnosis.

No supplement can correct faulty mechanics.

But supporting the environment in which tissues recover is part of supporting long-term musculoskeletal health.

This is not a treatment for recurrent neck or shoulder pain.
It is part of supporting how the system responds.

Want to Learn More?

If your shoulder pain keeps coming back, if treatments have failed, or if you feel like you still do not understand why your shoulder hurts, it may be time to look beyond a single MRI finding and evaluate the entire region.

The Patient's Guide to Ethical Regenerative Medicine

The Bottom Line

Shoulder pain is rarely as simple as a single MRI finding.

A rotator cuff tear may be part of the picture, but the biceps tendon, AC joint, shoulder mechanics, neck, and surrounding structures often determine whether the problem truly resolves or continues to return.

If your shoulder still hurts despite treatment, the answer may not be that nothing works.

The answer may be that the problem has never been fully explained.

To better movement,

Tammy J. Penhollow, DO
Architect of Spine and Joint Health
Precision Regenerative Medicine
Structure First. Precision Always.

If this helped you think about your symptoms more clearly, feel free to pass it along to someone dealing with something similar.

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