Learn best practices for chiropractic rehabilitation for shoulder pain to improve your recovery and overall health.

Educational Abstract: Integrative Management of Suprascapular Neuropathy With Evidence-Based, Multidisciplinary Care

In this educational post, I, Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, present a comprehensive, first-person walkthrough of an adolescent athlete with five months of progressive left shoulder pain, weakness, and nocturnal symptoms—ultimately consistent with suprascapular neuropathy. I reframe a clinical transcript into a narrative that takes you through my evaluation, the anatomical landmarks, reasoning for in-office intervention, and an integrative treatment plan that blends chiropractic care, medical oversight, functional medicine, targeted rehabilitation, and personal injury protocols. I also highlight how our multidisciplinary team at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas—collaborating under the medical direction of Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933)—utilizes modern, evidence-based diagnostics and interventions that reflect current literature from leading researchers in sports medicine, neurology, orthopedics, and pain science.

This post explains the anatomy and physiology of the suprascapular nerve and rotator cuff, the pathomechanics of compression at the suprascapular notch, and how we integrate ultrasound-guided assessment, electrodiagnostics, rehabilitative exercise science, chiropractic adjustments and mobilizations, soft tissue optimization, motor control retraining, progressive loading, and recovery strategies to restore function. I describe the rationale for specific techniques, including scapular kinematics, load management for young lifters, and when corticosteroid injections may be medically indicated. Throughout, I highlight the value of interprofessional collaboration—where the MD’s medical direction ensures safety, diagnostic rigor, and pharmacologic stewardship. At the same time, chiropractic and functional medicine approaches drive biomechanical correction and systems-level recovery.

The journey culminates with a data-driven, compassionate plan for sustained performance and long-term musculoskeletal health, grounded in patient education and shared decision-making.

Keywords: suprascapular neuropathy, suprascapular notch, supraspinatus, infraspinatus, rotator cuff, shoulder abduction, external rotation weakness, integrative chiropractic care, internal medicine oversight, corticosteroid injection, functional rehabilitation, sports medicine

Introduction to the Patient Case and Our Integrated Care Approach

I met an 18-year-old gentleman who had been lifting weights for seven to eight years. Over the last five months, he developed progressive, vague pain in his left shoulder, with notable weakness that slowly worsened. His pain increased at night, especially when lying on the left side. On examination, I observed clear atrophy of the left infraspinatus and supraspinatus, with asymmetry compared with the right side. He described difficulties in the gym with shoulder abduction and external rotation—classic complaints that raised my suspicion for suprascapular neuropathy caused by compression where the suprascapular nerve traverses the suprascapular notch.

At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic), we practice in a multidisciplinary framework that blends chiropractic musculoskeletal expertise with internal medicine oversight. I serve as an integrative clinician—chiropractor and advanced practice registered nurse (FNP-BC)—and my medical director and collaborative physician is Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine (NPI #1164426749; Texas MD License #J2933). Dr. Cardenas provides medical direction and ensures that any invasive procedures, pharmacologic considerations, and systemic risk factors are managed appropriately within the standards of care.

Together, we bring an evidence-based, team-centered model to shoulder pain and nerve entrapment syndromes. Our approach includes:

• Detailed history and physical exam emphasizing biomechanics and neuromuscular function
• Orthopedic and neurologic testing aligned with current evidence
• Imaging and electrodiagnostics when clinically indicated
• Integrative chiropractic interventions to restore joint mechanics and soft tissue function
• Medical oversight for injections and pharmacology when indicated
• Functional medicine perspectives on recovery, inflammation, and tissue healing
• Structured rehabilitation focusing on scapular control, rotator cuff endurance, and load management
• Ongoing monitoring and outcome tracking, particularly for athletes and active individuals

In this post, I will walk you through my clinical reasoning, demonstrate how we identify landmarks and perform a suprascapular nerve region intervention, and outline a complete care plan. I will also interweave findings from the latest research and clinical guidelines to ensure the narrative reflects modern best practices.

Understanding Suprascapular Neuropathy and Why Young Lifters Are at Risk

When an 18-year-old with years of weightlifting develops shoulder pain and weakness in abduction and external rotation—combined with supraspinatus and infraspinatus atrophy—the suspicion of suprascapular neuropathy is strong. The suprascapular nerve arises from the upper trunk of the brachial plexus (C5-C6, occasionally C4 contributions) and provides motor innervation to:

• The supraspinatus muscle in the supraspinous fossa
• The infraspinatus muscle in the infraspinous fossa

The nerve traverses the suprascapular notch beneath the superior transverse scapular ligament and then winds around the spine of the scapula to the spinoglenoid notch. The most common entrapment sites are:

• The suprascapular notch, which, if narrowed or if the ligament ossifies, can compress the nerve before it supplies the supraspinatus and infraspinatus
• The spinoglenoid notch, which tends primarily to affect the infraspinatus

Persistent mechanical stress—such as heavy lifting, repetitive overhead movements, and scapular dyskinesis—can lead to dynamic compression of the nerve. Over time, compression may cause demyelination and axonal loss, manifesting as weakness and muscle atrophy. In young athletes and lifters, subtle scapulothoracic dyskinesis, inadequate posterior shoulder flexibility, and imbalances between prime movers and stabilizers can predispose to nerve irritation and traction injuries.

Important risk elements include:

• Repetitive abduction and external rotation under load
• Cross-body motions with protraction and forward head posture
• Hypertrophy in surrounding musculature leading to confined spaces around the notch
• Labral or paralabral cysts at the spinoglenoid notch compressing the nerve
• Poor scapular upward rotation and posterior tilt mechanics
• Posterior capsular tightness contributing to altered humeral head kinematics
• Insufficient recovery, poor sleep, and high cumulative load

The clinical presentation aligns with research that shows suprascapular neuropathy in overhead athletes and lifters, especially with dominant-side shoulder demands. The nuance, however, is that the nerve may be compromised at different points along its course, and the pattern of motor deficits and atrophy can help localize the compression site. Weakness in both abduction initiation (supraspinatus) and external rotation (infraspinatus), with visible atrophy in each, suggests involvement at or proximal to the suprascapular notch, before the nerve branches into separate divisions for the supraspinatus and infraspinatus.

Key Physiological Concepts Behind Nerve Compression and Muscle Atrophy

To fully grasp why this condition progresses, it helps to understand the physiology of nerves and muscles under compressive stress:

• Nerve fibers rely on adequate blood flow and axonal transport. Compression at the notch can impede perfusion and disrupt axonal transport of neurotrophic factors, leading to demyelination and eventual axonal injury.
• Chronic compression can create a cycle: local ischemia, inflammation, increased endoneurial pressure, and eventual fibrosis. These changes manifest as decreased conduction velocity and reduced motor unit recruitment.
• Muscles innervated by a compromised nerve lose trophic support and neural activation. Over time, this can lead to atrophy and fatty infiltration if not reversed. Early intervention can prevent or reverse denervation atrophy, but prolonged compression increases the risk of permanent deficits.
• Pain mechanisms involve both nociceptive and neurogenic components. Peripheral sensitization from inflamed tissues and central sensitization in chronic cases can amplify pain perception. Addressing both mechanical and neurophysiological drivers is essential.

By appreciating these dynamics, our interventions aim to restore neural gliding, reduce compressive forces, correct scapular mechanics, and support tissue recovery through a targeted, progressive plan.

Clinical Examination: What I Saw and Why It Matters

From the first moment, I focused on three pillars: observation, palpation, and functional testing.

• Observation: Visible atrophy of the left supraspinatus and infraspinatus compared to the right. The infraspinatus fossa appeared flattened. Scapular asymmetry with subtle winging during elevation indicated scapular dyskinesis.
• Palpation: Tenderness along the suprascapular notch and supraspinatus fossa; increased tone and trigger points in upper trapezius and posterior deltoid; signs of posterior shoulder tightness.
• Range of Motion: Pain with abduction and external rotation, especially mid-range abduction. End-range elevation revealed compensatory upper trapezius activation and scapular shrug.
• Strength: Marked weakness in early abduction (supraspinatus) and external rotation (infraspinatus), consistent with suprascapular nerve compromise.
• Special Tests: Positive impingement symptoms were secondary but present; resisted external rotation fatigue occurred early. Cross-body adduction revealed posterior tightness.

Given this constellation, suprascapular neuropathy at the notch was the leading consideration. Differential diagnoses still needed discussion:

• Cervical radiculopathy (C5-C6): We screened the cervical spine and upper quarter neuro exam to rule out radicular patterns.
• Rotator cuff tear: Particularly supraspinatus tear; however, the atrophy pattern and neurological weakness were more consistent with denervation than a primary tear alone.
• Labral pathology with spinoglenoid cyst: Especially if isolated infraspinatus involvement is present; in this case, supra- and infra-weakness pointed proximally.
• Parsonage-Turner Syndrome: Typically acute neuropathic pain with subsequent weakness; presentation here was insidious and progressive.
• Quadrilateral space syndrome: Would affect posterior shoulder and axillary nerve distribution, less consistent with the observed pattern.

We consider imaging (MRI, ultrasound) and nerve conduction studies when needed. In a young athlete with progressive weakness and visible atrophy, I often coordinate with Dr. Cardenas to determine timing for electrodiagnostics if improvement stalls or if we anticipate the need for surgical referral in the rare case of refractory compression by a structural lesion.

Integrative Team Structure: How We Coordinate Patient Care

At our clinic, Dr. Cardenas serves as Medical Director and Collaborative Physician. Her role ensures our protocols are medically sound and coordinated across disciplines. My role includes chiropractic assessment and intervention, functional rehabilitation planning, and advanced practice nursing oversight within collaborative practice, enabling me to integrate functional medicine considerations and coordinate care across specialists.

Our integrated process includes:

• Medical Oversight: Dr. Cardenas reviews cases where injections, medications, or advanced imaging are considered. She oversees procedure quality and safety and ensures we identify internal medicine risks (e.g., bleeding risk, metabolic concerns).
• Chiropractic and Rehabilitation: I lead biomechanical assessment, joint and soft tissue interventions, neurodynamic mobilization, and structured exercise programming aligned with sports science.
• Functional Medicine Layer: We evaluate nutritional status, inflammation, sleep quality, and recovery metrics to optimize tissue healing and nervous system health.
• Personal Injury and Documentation: We provide detailed documentation for athletes, students, and those with personal injury considerations, ensuring communication with insurers, coaches, and families.
• Referrals: Where structural lesions or refractory cases require surgical or neurologic consultation, we coordinate timely referrals.

This collaborative framework underpins safe, effective care.

Step-by-Step: Locating Landmarks and Performing the Targeted Injection

During this visit, given the intensity and progression of symptoms, we planned a targeted therapeutic injection in the supraspinatus fossa near the suprascapular notch, as part of a broader conservative care protocol. In many cases, we use ultrasound guidance to improve precision and safety, and Dr. Cardenas provides oversight and medical direction for these procedures. Here is how I approached this intervention:

• I palpated the coracoid process and marked it. Noting patient feedback, I ensured tenderness was assessed without undue pressure.
• I traced the spine of the scapula, marked its medial border, and identified the acromion tip.
• I determined the midpoint between the spine of the scapula and acromion. I drew a line toward the coracoid process to approximate the supraspinatus fossa and the region above the suprascapular notch.
• Once I identified the injection point at the midpoint over the fossa, I marked it gently with the retracted tip of a pen.
• I prepped the skin with alcohol and betadine, removing extraneous marks and ensuring a sterile field.
• I prepared 1 mL of 1% lidocaine with epinephrine and 1 mL of corticosteroid solution, using a 1-inch 25-gauge needle. Under cooling spray (Pain Ease vapor coolant) to minimize surface discomfort, I inserted the needle perpendicular to the skin, lightly contacted the bone, withdrew approximately 1 mm, aspirated to avoid intravascular injection, and delivered the medication.
• I avoided the suprascapular artery by careful technique and anatomical caution. After injection, I applied a bandage.
• Immediately after the procedure, I guided the patient through gentle abduction and external rotation to facilitate dispersion within the local fascial planes while monitoring for adverse reactions.

In our setting, precise technique and adherence to safety protocols are essential. With medical oversight, we ensure that patients are appropriately screened for contraindications and that post-procedural care is planned and communicated clearly.

Why an Injection Here? The Rationale for Targeted Anti-Inflammatory Support

In cases of suprascapular neuropathy with inflammatory components around the notch or supraspinatus fossa, a carefully placed injection can reduce local inflammatory mediators, alleviate pain, and allow for more effective participation in rehabilitation. The goals include:

• Reducing perineural inflammation and edema that may exacerbate compression
• Interrupting pain-spasm cycles to facilitate neuromuscular retraining
• Enhancing tolerance to corrective exercise by reducing nociceptive drive

However, injections are not standalone solutions. They are part of a larger plan that corrects mechanics, addresses load errors, and restores neural health. Repeated steroid injections are minimized due to risks such as tendon weakening or systemic effects. Our practice emphasizes that injections bridge the gap to improved movement and restored strength.

Integrative Chiropractic Care: How Manual Interventions Support Nerve Recovery

Chiropractic care shines in restoring optimal joint mechanics, soft tissue function, and neuromuscular control. For this patient, our focus areas included:

• Cervicothoracic Junction Mobility: The C5-C6 contributions to the suprascapular nerve and overall scapular control rely on a well-functioning cervicothoracic spine. Gentle mobilizations and adjustments at the cervical spine, first rib, and thoracic segments improve scapular upward rotation and posterior tilt mechanics.
• Scapulothoracic Coordination: Soft tissue techniques for the upper trapezius, levator scapulae, pectoralis minor, and serratus anterior facilitated improved scapular kinematics. Targeted myofascial work in the posterior shoulder addressed posterior capsule tightness and infraspinatus trigger points.
• Glenohumeral Arthrokinematics: Specific mobilizations addressed posterior and inferior capsular tightness to reduce anterior-superior humeral head translation during elevation, diminishing compressive loads at the notch.
• Neurodynamic Techniques: Gentle nerve glides for the suprascapular and related brachial plexus elements maintained neural mobility, discouraging adhesions and sensitization.

Each manual technique has a clear physiological rationale: improve joint motion, reduce local tone and myofascial restriction, normalize afferent input, and promote coordinated motor output. The combination is synergistic with rehabilitation exercises.

Functional Rehabilitation: Building a Shoulder That Can Withstand Load

A comprehensive rehabilitation strategy is central to reversing atrophy and restoring performance. Our phased approach includes:

• Early Phase (Pain-Modulated, Neural Recovery)

• • Isometrics for external rotation and scapular retraction to engage the supraspinatus and infraspinatus without provoking symptoms.
  • Gentle range of motion and scapular control drills (posterior tilt, upward rotation, controlled scapular setting)
  • Neurodynamic glides for brachial plexus and suprascapular nerve
  • Low-load blood flow restriction (BFR) where appropriate to stimulate hypertrophy while keeping joint stresses minimal
  • Emphasis on diaphragmatic breathing and rib mechanics to support thoracic mobility and scapular function

• Middle Phase (Strength and Control)

• • Progressive external rotation at neutral, then at 45-90 degrees abduction
  • Prone horizontal abduction variations with scapular depression and retraction
  • Serratus anterior strengthening (wall slides, plus variations, dynamic protraction)
  • Posterior cuff endurance circuits with tempo control
  • Posterior capsule and horizontal adduction flexibility work to normalize glenohumeral motion

• Late Phase (Power and Return to Lifting)

• • Integration into compound lifts with strict form and limited loads initially
  • Plyometric shoulder drills for athletes requiring high-speed power
  • Sport-specific or lift-specific progressions (pressing, pulling, overhead work) with precise load increments
  • Ongoing scapular mechanics coaching and fatigue management strategies

We measure success not only by pain reduction but by improvements in torque, fatigue resistance, scapular kinematics, and return-to-sport readiness.

Load Management for Teen Athletes: Preventing Recurrence

For young lifters, a “more is better” culture can undermine shoulder health. Education is crucial:

• Avoid aggressive overhead loading until scapular mechanics and cuff strength are balanced.
• Blend horizontal pulling with pressing, aiming for a 2:1 pulling-to-pressing ratio during rehabilitation.
• Limit end-range abduction and extreme external rotation under heavy load until you demonstrate control.
• Sleep hygiene is part of the program—nocturnal pain often reflects irritation that requires load reduction and improved nocturnal positioning (e.g., hugging a pillow to support the shoulder).

Working with coaches and families, we set realistic timelines to avoid rushed returns that risk re-injury.

Functional Medicine Insights: Supporting Nerve and Tissue Healing

Beyond biomechanics, system-level recovery matters:

• Nutrition: Adequate protein (1.6–2.2 g/kg/day in athletes), omega-3 fatty acids, and micronutrients (B vitamins, magnesium, vitamin D) support neuromuscular repair.
• Inflammation: We target modifiable lifestyle factors—sleep duration and quality, stress management, and glycemic control—to create a healing environment.
• Recovery: Periodized training, deliberate deload weeks, and monitoring subjective recovery scales reduce the risk of cumulative overload.

By integrating these elements, we improve resilience and tissue regeneration.

Medical Oversight by Dr. Cardenas: Safety, Precision, and Standards of Care

Dr. Maria Guadalupe Cardenas, MD, brings over 40 years of internal medicine experience. She ensures:

• Screening for red flags, systemic conditions, and contraindications to injections or medications
• Consideration of advanced diagnostics (ultrasound, MRI, EMG/NCS) when indicated
• Pharmacologic prudence—balancing risks and benefits of anti-inflammatories, ensuring appropriate dosing, and preventing overreliance on injections
• Coordination with specialists if structural lesions (e.g., paralabral cysts) necessitate surgical evaluation

Our collaboration places the patient’s safety and long-term outcomes at the center. Medical rigor and careful monitoring enhance the chiropractic and functional interventions.

Immediate Post-Procedure Care and Movement Integration

Following the injection, I guided the patient through:

• Gentle abduction and external rotation
• Progressive active range-of-motion
• Light self-massage around the fossa to facilitate dispersion and proprioceptive input

This immediate movement supports improved tissue permeability and reduces fear of movement. The key is graded exposure to motion aligned with symptom response.

Monitoring Progress: Objective Measures and Decision Points

We track:

• Strength in external rotation at varying abduction angles
• Endurance tests for posterior cuff (time under tension metrics)
• Scapular kinematics observed during elevation tasks
• Pain at night and positional tolerances
• Return-to-lift criteria and technique fidelity

If weakness persists beyond expected timelines or if new neurological findings arise, we escalate to electrodiagnostics and advanced imaging. The goal is to avoid delay in addressing structural causes that require different interventions.

Clinical Observations From Practice: Patterns I Often See

From my published observations and clinical commentaries (see WellnessDoctorRX and my professional updates), I’ve noted:

• Young lifters with early- and mid-range abduction weakness often have combined supraspinatus and infraspinatus atrophy indicating proximal nerve involvement.
• Posterior shoulder tightness paired with anterior scapular tilt and poor serratus activation worsens notch compression.
• Athletes who prioritize heavy pressing and neglect pulling and posterior cuff work exhibit higher rates of symptomatic patterns.
• Sleep-side dominance and poor nighttime shoulder support exacerbate symptoms.
• Initial improvement after a single well-placed injection, combined with a robust rehabilitation plan, is common, but sustained gains require ongoing mechanics correction and load cycling.

These insights guide our emphasis on holistic correction rather than symptom-only relief.

Risk Mitigation: Steroid Use and Tissue Health

We are judicious with corticosteroids:

• Limit frequency to avoid tendon weakening
• Favor ultrasound guidance when available
• Pair with strict rehabilitation to take advantage of the window of reduced pain
• Consider alternatives such as platelet-rich plasma in certain chronic tendinopathies if evidence and case specifics support it.

Patient education includes discussion of benefits, risks, and the central role of movement re-education.

The Patient’s Journey: From Pain to Performance

With integrated care, our 18-year-old patient embarked on a structured path:

• Phase 1: Pain control, neural mobility, scapular control
• Phase 2: Strength and endurance restoration
• Phase 3: Return to progressive lifting with technique coaching
• Maintenance: Periodic check-ins, continued posterior cuff and serratus work, and adherence to load management

His nocturnal pain decreased, external rotation strength improved, and visible atrophy attenuated as muscle activation and hypertrophy returned. Most importantly, he learned to listen to early signals and adjust training proactively.

Education and Empowerment: The Core of Our Model

We emphasize:

• Understanding anatomy: Knowing where the nerve travels and how mechanics affect it
• Movement literacy: Mastering scapular positioning and cuff activation cues
• Recovery discipline: Respecting sleep, nutrition, and deloading cycles
• Collaborative care: Communicating openly with coaches, parents, and medical team

Our goal is not just symptom relief—it is building self-efficacy and long-term shoulder resilience.

Practical Tips for Athletes and Lifters With Shoulder Pain

• Reduce overhead pressing volume temporarily; emphasize controlled external rotation and scapular drills.
• Train pulling patterns more than pressing during recovery phases.
• Use gentle posterior capsule stretches and avoid aggressive end-range loading early on.
• Sleep with shoulder support—consider a pillow across the chest to prevent excessive adduction/internal rotation.
• Warm up with scapular upward rotation drills and low-load activation (e.g., wall slides with plus).
• Monitor daily readiness; if pain resurges, back off volume and intensity.

When to Seek Medical Evaluation

• Progressive weakness or visible atrophy in the supraspinatus/infraspinatus region
• Persistent nocturnal pain unresponsive to rest.
• Neurologic symptoms such as paresthesia, though less common in this pattern
• Failure to improve with conservative care or recurrence under modest loads

A timely evaluation prevents chronic denervation and supports better outcomes.

How Integrative Chiropractic Fits Within the Evidence Base

Modern literature supports an integrated approach:

• Biomechanical correction reduces abnormal loads and improves shoulder function
• Rehabilitation targeting scapular control and posterior cuff endurance improves outcomes in shoulder pain syndromes
• Selective injections can provide a window for therapeutic exercise in carefully chosen cases
• Systems-level considerations (sleep, nutrition) influence healing trajectories

We align with this evidence by combining precise manual care, structured rehabilitation, medical oversight, and functional medicine insights.

Summary and Call to Action

In this case, an 18-year-old lifter presented with five months of progressive left shoulder pain and weakness, with visible atrophy of the supraspinatus and infraspinatus, suggestive of suprascapular neuropathy at the notch. Through careful assessment, a targeted injection under medical oversight, integrative chiropractic care, and a robust rehabilitation plan, we addressed both the symptoms and the root causes. Our multidisciplinary model at Injury Medical Clinic PA, with Dr. Maria Guadalupe Cardenas as Medical Director and Collaborative Physician, ensures a high standard of safety and evidence-based practice for athletes and active individuals alike.

If you or your athlete has similar symptoms, an integrated evaluation can clarify the cause and set a path to safe, sustainable recovery.

References

• Suprascapular neuropathy in athletes: diagnosis and management (Cummins, C. A., Messer, T. M., Nuber, G. W., 2017). Current Reviews in Musculoskeletal Medicine.
• Scapular dyskinesis: From basic science to clinical practice (Kibler, W. B., Sciascia, A., 2013). Journal of Orthopedic & Sports Physical Therapy.
• Rotator cuff tendinopathy and shoulder impingement in athletes (Lewis, J. S., 2009). JOSPT.
• The role of scapular positioning in shoulder impingement and rotator cuff pathology (Ludewig, P. M., Cook, T. M., 2003). JOSPT.
• Neurodynamics and nerve entrapments in the upper limb (Butler, D., Shacklock, M., 2015). Manual Therapy.
• EMG and nerve conduction studies in suprascapular neuropathy (General reference: Neurology practice updates).
• Ultrasound-guided injections for shoulder conditions (Humphrey, J. A., Kelly, J. D., 2019). PM&R.
• Posterior capsule tightness and shoulder pathology (Tyler, T. F., et al., 2010). JOSPT.
• Blood flow restriction training for rehabilitation (Hughes, L., Patterson, S. D., 2019). Scandinavian Journal of Medicine & Science in Sports.
• Nutritional support for tendon and muscle healing (Close, G. L., et al., 2019). Strength & Conditioning Journal.

Note: This educational post synthesizes current best practices and research. Qualified clinicians should tailor care plans to each patient.

SEO tags: suprascapular neuropathy, suprascapular nerve, suprascapular notch, supraspinatus atrophy, infraspinatus atrophy, shoulder abduction weakness, external rotation weakness, young athlete shoulder pain, integrative chiropractic, internal medicine collaboration, corticosteroid injection shoulder, scapular dyskinesis, rotator cuff rehabilitation, functional medicine shoulder, El Paso chiropractor, Injury Medical Clinic PA, Mission Plaza Injury Medical Clinic, Dr. Maria Guadalupe Cardenas MD, Dr. Alex Jimenez DC, evidence-based shoulder care