Pain in the shoulder, elbow, or hand can significantly impair daily activities and upper body performance. These regions are highly vulnerable to overuse injuries, nerve entrapments, tendon degeneration, trauma, and joint instability. Whether from sports, repetitive movements, or age-related wear, upper extremity pain can impact strength, mobility, and fine motor function.
At the Performance Medicine Institute, our science-based, multidisciplinary approach includes detailed biomechanics assessments, diagnostic ultrasound, joint and tendon assessments, manual therapy, neuromuscular retraining, interventional procedures, and regenerative therapies. We treat a wide range of upper extremity conditions, including:
Rotator Cuff Tendinitis / Tear
The rotator cuff is a group of four muscles and tendons that stabilize the shoulder joint. When it comes to rotator cuff tears, the science is very clear – most patients with chronic rotator cuff tears do better by not undergoing surgery. Our protocol is based on scientific studies our team and others have published, and is able to effectively restore pain free shoulder function for individuals from a variety of activity levels. By treating inflammation in the joint capsule, mobilizing the shoulder joint and scapula, and targeted strengthening of periscapular muscles, we are able to effectively treat rotator cuff tears without undergoing surgery.
Shoulder Impingement Syndrome
Impingement occurs when rotator cuff tendons or the bursa become compressed beneath the acromion. It often results from poor shoulder mechanics, muscle imbalance, or structural narrowing. Symptoms include pain with lifting, reaching, or sleeping on the shoulder. Care focuses on scapular stabilization, postural correction, and anti-inflammatory interventions.
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is characterized by progressive stiffness, pain, and loss of shoulder mobility. It often develops after surgery, injury, or periods of immobility and may be associated with diabetes or thyroid dysfunction. Treatment includes joint mobilization, capsule stretching, pain management, and gradual restoration of movement.
Labral Tear (SLAP or Bankart)
The shoulder labrum is a fibrocartilaginous rim that stabilizes the ball-and-socket joint. Tears can occur from trauma, dislocation, or repetitive stress. SLAP tears affect the top of the labrum, while Bankart lesions involve the lower front portion. Patients may experience clicking, catching, or instability. We provide targeted rehab, kinetic chain retraining, and, when indicated, post-surgical recovery protocols.
Ulnar Collateral Ligament Tears
The ulnar collateral ligament (UCL) is one of the main stabilizers of the elbow joint. While UCL tears were once thought to always require surgery to repair, for many patients there are highly effective non-operative treatments available. We offer an integrated treatment approach, including dry needling, bracing, laser therapy, regenerative injections, and biological therapies.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow results from microtears in the extensor tendons on the outer elbow due to repetitive gripping or wrist extension. It causes lateral elbow pain, especially during lifting or twisting. Treatment includes eccentric loading programs, dry needling, laser therapy, regenerative injections, and activity modification.
Golfer’s Elbow (Medial Epicondylitis)
This condition affects the tendons on the inside of the elbow and presents with pain during wrist flexion or forearm pronation. It commonly occurs in activities requiring repetitive wrist motion. We address this through myofascial release, tendon loading strategies, bracing, and correction of movement imbalances.
Ulnar Nerve Entrapment / Cubital Tunnel Syndrome
Compression of the ulnar nerve at the elbow can cause numbness, tingling, or weakness in the ring and pinky fingers. Symptoms often worsen at night or with prolonged elbow flexion. Management includes nerve gliding, ergonomic correction, and activity modification. In advanced cases, injection or surgical decompression may be considered.
Carpal Tunnel Syndrome
Carpal tunnel syndrome involves compression of the median nerve as it passes through the wrist. It causes numbness, tingling, and weakness in the thumb, index, and middle fingers. Contributing factors include repetitive use, wrist position, and fluid retention. Treatment focuses on nerve mobilization, wrist stabilization, ergonomic adjustment, and ultrasound-guided corticosteroid injections when appropriate.
De Quervain’s Tenosynovitis
This condition involves inflammation of the tendons at the base of the thumb, often from repetitive thumb motion or lifting. Patients report pain with gripping, pinching, or twisting movements. Conservative care includes thumb spica splinting, tendon glides, laser, anti-inflammatory treatment, and soft tissue mobilization.
Trigger Finger
Trigger finger occurs when the flexor tendon thickens or catches in its sheath, causing painful locking or clicking during finger movement. It often develops from repetitive hand use or systemic inflammation. We offer conservative treatment including splinting, dry needling, thermal ultrasound, Xiaflex collagenase treatments, and ultrasound-guided injections to reduce inflammation and restore motion.