Shoulder Problems and Injuries

Overview

Minor shoulder problems, such as sore muscles and aches and pains, are common. Shoulder problems develop from everyday wear and tear, overuse, or an injury. They can also be caused by the natural process of aging.

Your shoulder joints move every time you move your arms. To better understand shoulder problems and injuries, you may want to learn more about the shoulder joint itself. The shoulder is a ball-and-socket joint. It has three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or cause problems. The acromioclavicular (AC) joint, which lies over the top of the shoulder, is also easily injured.

Shoulder problems can be minor or serious. Symptoms may include pain, swelling, numbness, tingling, weakness, changes in temperature or color, and changes in your range of motion. Shoulder injuries most often occur during sports activities, work-related tasks, projects around the home, or falls. Home treatment often can help relieve minor aches and pains.

Sudden (acute) injury

Injuries are the most common cause of shoulder pain.

A sudden (acute) injury may occur from a fall on an outstretched arm, a direct blow to the shoulder, or abnormal twisting or bending of the shoulder. Pain may be sudden and severe. Bruising and swelling may occur soon after the injury. Sometimes nerves or blood vessels may be injured or pinched during the injury. In that case, the shoulder, arm, or hand may feel numb, tingly, weak, or cold, or it may look pale or blue. Acute injuries include:

• Bruises (contusions). They occur when small blood vessels under the skin tear or rupture, often from a twist, bump, or fall. Blood leaks into tissues under the skin and causes a black-and-blue color that often turns purple, red, yellow, and green as the bruise heals.
• Injuries to the tough, ropy fibers (ligaments) that connect bone to bone and help stabilize the shoulder joints (sprains).
• Injuries to the tough, ropy fibers that connect muscle to bone (tendons).
• Pulled muscles (strains).
• Injuries to nerves, such as brachial plexus neuropathy.
• Separation of the shoulder. This occurs when the outer end of the collarbone (clavicle) separates from the end (acromion) of the shoulder blade because of torn ligaments. This injury occurs most often from a blow to a shoulder or a fall onto a shoulder or outstretched hand or arm.
• Damage to one or more of the four tendons that cover the shoulder joint (torn rotator cuff). This damage may occur from a direct blow to or overstretching of the tendon.
• Broken bones (fractures). A break may occur when a bone is twisted, struck directly, or used to brace against a fall.
• Pulling or pushing bones out of their normal position among the other bones that make up the shoulder joint (subluxation or dislocation).

Overuse injuries

You may not recall having a specific injury, especially if symptoms began slowly or during everyday activities. Overuse injuries occur when too much stress is placed on a joint or other tissue. This often happens when you overdo or repeat an activity. Overuse injuries include:

• Inflammation of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, a tendon, or the skin. This inflammation is called bursitis.
• Inflammation of the tough, ropy fibers that connect muscles to bones (tendinitis). Bicipital tendinitis is an inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation usually occurs along the groove (bicipital groove) where the tendon passes over the humerus to attach just above the shoulder joint.
• Muscle strain.
• A frozen shoulder. This is a condition that limits shoulder movement. It may follow an injury.
• Overhead arm movements. They may cause tendons to rub or scrape against a part of the shoulder blade called the acromion. This rubbing or scraping may lead to abrasion or inflammation of the rotator cuff tendons. (This is also called impingement syndrome.)

Other causes of shoulder symptoms

Overuse and acute injuries are common causes of shoulder symptoms. Less common causes include:

• Muscle tension or poor posture.
• Pain that's coming from somewhere else in your body (referred shoulder pain).
• Breakdown of the cartilage that protects and cushions the shoulder joints (osteoarthritis).
• Calcium buildup in the tendons of the shoulder.
• An irritated or pinched nerve or a herniated disc in the neck.
• Infection in the skin (cellulitis), joint (infectious arthritis), bursa (septic bursitis), or bone (osteomyelitis).
• Cancer that has spread to the bones of the shoulder or spine.
• Abuse. Any shoulder injury (especially a dislocated shoulder) that can't be explained, doesn't match the explanation, or occurs more than once may be caused by abuse.

Treatment

Treatment for a shoulder injury may include first aid, physical therapy, and medicine. In some cases, surgery is needed. Treatment depends on:

• The location and type of injury, and how bad it is.
• How long ago the injury occurred.
• Your age, health condition, and activities, such as work, sports, or hobbies.

Self-Care

First aid for a possible broken bone

Most minor shoulder problems will heal on their own, and home treatment is usually all that's needed. But if you think that you might have a more severe problem, use first aid until you can be seen by a doctor.

• Control bleeding with direct pressure to the wound.
• Remove all rings or bracelets. It may be hard to remove the jewelry after swelling starts.
• Use a sling to support an injured shoulder.
• If a bone is sticking out of the skin, don't try to push it back into the skin. Cover the area with a clean bandage.

Minor shoulder problem or injury

Try the following tips to help relieve shoulder pain, swelling, and stiffness.

• Rest.

  It's important to rest and protect the affected area. Stop, change, or take a break from any activity that may be causing your pain or soreness.

• Use ice.

  Put ice or a cold pack on your shoulder for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake).

• Elevate the affected area.

  Try to keep the area at or above the level of your heart to help reduce swelling. Prop up the area on pillows while you apply ice and anytime you sit or lie down.

• Wear a sling.

  For 48 hours, wear a sling if it makes you more comfortable and supports your shoulder.

• Avoid things that might increase swelling.

  For 48 hours, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.

• Apply heat.
  • After 2 or 3 days, you can try applying heat to the area that hurts. Types of heat therapy include microwavable packs and disposable heating patches.
  • Apply heat for 10 to 20 minutes at a time.
  • You might also try switching between cold and heat.
• Rub the area.

  Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the affected area if it causes pain.

• Move your arm.

  Try bending forward at the waist and let your affected arm hang straight down. Move your hips and legs, and let that motion gently swing your arm back and forth.

• Don't smoke or use other tobacco products.

  Smoking slows healing because it decreases blood supply and delays tissue repair.

If you need to use a sling for more than 48 hours, you may have a more serious injury that needs to be checked by a doctor.

Signs of possible abuse

Most injuries are not caused by abuse. But bruises are often the first sign of possible abuse. Suspect physical abuse of a child or vulnerable adult when:

• Any injury cannot be explained or does not match the explanation.
• Repeated injuries occur.
• Explanations change for how the injury happened.

You may be able to prevent further injuries by reporting abuse. Seek help if:

• You suspect child abuse or elder abuse. Call your local child or adult protective agency, police, or a health professional, such as a doctor, nurse, or counselor.
• You or someone you know is experiencing intimate partner violence (IPV).
• You have trouble controlling your anger with a child or other person in your care.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse pain or swelling.
• New signs of infection, such as redness, warmth, pus, or a fever.
• New or worse numbness, tingling, or cool and pale skin.
• Movement or strength decreases.
• Symptoms occur more often or are more severe.

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