Shoulder Injury

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KEY POINTS

• A shoulder injury is a bruise, strain, sprain, break, or dislocation that affects the muscles, tendons, and ligaments of your shoulder. It is most often caused by a fall, direct hit to your shoulder, or by overuse.
• Change or stop doing the activities that cause pain until the injury heals.
• A shoulder injury may be treated with medicine, a shoulder immobilizer, exercise, ice, or sometimes surgery.

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What is a shoulder injury?

A shoulder injury is a bruise, strain, sprain, break, or dislocation that affects some part of your shoulder.

Your shoulder is made up of your collarbone, shoulder blade, the top of your upper arm bone, and the muscles, tendons, and ligaments that form your shoulder joint. (A tendon is a strong band of tissue that connects bones to muscle. Ligaments are strong bands of tissue that connect one bone to another and hold the bones of a joint together.)

What is the cause?

Shoulder injuries are common, especially if you play contact sports or a sport where you fall often. A fall or direct hit may cause:

• A break or crack in one or more of the bones in your shoulder.
• A separation or dislocation, which happens when the bones, muscles, and other tissues in your shoulder joint are moved out of place, torn, or overstretched.

Baseball pitchers, golfers, swimmers, and tennis players often have overuse injuries of the shoulder. An overuse injury is caused by doing one activity over and over, so you may also have this problem if you work with hand tools or use your shoulders a lot on the job.

Overuse injuries and aging can cause problems in any part of your shoulder. For example:

• Tendonitis or tendinosis is irritation, swelling, or tiny tears in a tendon. If you have a complete tear of your tendon, it is called a rupture.
• Bursitis is irritation and swelling of a fluid-filled sac that surrounds a joint or tendon.
• Bone spurs are areas of extra bone growth after repeated wear and tear in the parts of your shoulder where bones meet each other, like the joint of your shoulder.

What are the symptoms?

The symptoms after a fall or direct hit may start right away. Symptoms of overuse injuries or aging may develop slowly. Symptoms may include:

• Pain or tenderness, with or without movement of your arm or shoulder
• Decreased ability to move your arm or shoulder
• Weakness
• Swelling
• Bruising

How is it diagnosed?

Your healthcare provider will ask about your symptoms, medical history, and activities and examine you. Tests may include X-rays or other scans such as:

• CT scan, which uses X-rays and a computer to show detailed pictures of your shoulder
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the bones, shoulder joint, and tissues
• Arthrogram, which is an X-ray or MRI taken after dye is injected into your joint to outline its shape

How is it treated?

Treatment depends on the type of injury.

• If your injury is caused by overuse, you will need to change or stop doing the activities that cause pain until your shoulder has healed. Your healthcare provider may recommend stretching and strengthening exercises to help you heal. Moist heat, ultrasound, and other types of physical therapy can also help.
• Your provider may give you prescription pain medicine.
• Your provider may give you a shot of steroid medicine to lessen any swelling and irritation caused by your injury.
• If your shoulder is separated or dislocated, your healthcare provider may place your shoulder and arm in a sling called a shoulder immobilizer after putting the shoulder joint back into place. The sling will keep your arm next to your body and stop you from moving your shoulder. Your provider will tell you if you should start exercises during this time or after you are no longer wearing the sling.
• If you have a fracture or a torn tendon, you may need surgery.

How can I take care of myself?

To relieve pain and help the injury heal:

• Rest.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured ribs every 3 to 4 hours for up to 20 minutes at a time.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
• Put moist heat on the sore area for 10 to 15 minutes before you do warm-up and stretching exercises. Moist heat may help relax your muscles. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a warm wet washcloth, or a hot shower. To prevent burns to your skin, follow directions on the package and do not lie on any type of hot pad. Don’t use heat if you have swelling.

Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent shoulder injury?

To help prevent shoulder injuries:

• Do a proper warm-up before throwing or overhead activities.
• Use proper form and posture in your activities or sports.
• Learn how to fall properly. You should tuck and roll to avoid falling onto an outstretched arm.
• As you recover from a shoulder injury, be sure to follow a conditioning program to develop strength and flexibility in and around the joint. Do range-of-motion exercises often during the day.