Shoulder Problems and Injuries
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 review the anatomy and function of the shoulder. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collarbone (clavicle), and 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 lays 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, or changes in your range of motion. Shoulder injuries most commonly 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 develop soon after the injury. If nerves or blood vessels have been injured or pinched during the injury, the shoulder, arm, or hand may feel numb, tingly, weak, or cold, or may look pale or blue. Acute injuries include:
- Bruises (contusions), which 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, ropelike fibers (ligaments) that connect bone to bone and help stabilize the shoulder joints (sprains).
- Injuries to the tough, ropelike fibers that connect muscle to bone (tendons).
- Pulled muscles (strains).
- Injuries to nerves, such as brachial plexus neuropathy.
- Separation of the shoulder, which 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), which 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 relationship to the other bones that make up the shoulder joint (subluxation or dislocation).
You may not recall having a specific injury, especially if symptoms began gradually or during everyday activities. Overuse injuries occur when too much stress is placed on a joint or other tissue, often by overdoing an activity or through repetition of 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 (bursitis).
- Inflammation of the tough, ropelike 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, which is a condition that limits shoulder movement and may follow an injury.
- Overhead arm movements, which 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 (also called impingement syndrome).
Other causes of shoulder symptoms
Overuse and acute injuries are common causes of shoulder symptoms. Less common causes of shoulder symptoms include:
- Muscle tension or poor posture.
- Pain that is 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).
- Invasive cancer that has spread to the bones of the shoulder or spine.
- Abuse. Any shoulder injury (especially a dislocated shoulder) that cannot be explained, does not match the explanation, or occurs repeatedly may be caused by abuse.
Treatment for a shoulder injury may include first aid measures, physical therapy, medicine, and in some cases surgery. Treatment depends on:
- The location, type, and severity of the injury.
- How long ago the injury occurred.
- Your age, health condition, and activities, such as work, sports, or hobbies.
Use the Check Your Symptoms section to decide if and when you should see a doctor.
First aid for a suspected broken bone
- Control bleeding . Apply steady, direct pressure for a full 15 minutes. Use a clock—15 minutes can seem like a long time. Resist the urge to peek after a few minutes to see whether bleeding has stopped. If blood soaks through the cloth, apply another one without lifting the first. If there is an object in the wound, apply pressure around the object, not directly over it.
- Remove all bracelets or rings. It may be difficult to remove the jewelry once swelling develops. See a picture of how to remove a ring that won't come off easily.
- Use a sling to support an injured shoulder.
- If a bone is sticking out of the skin, do not try to push it back into the skin. Cover the area with a clean bandage.
If a cast or splint is applied, it is important to keep it dry and to try to move the uninjured parts of your limb as normally as possible to help maintain muscle strength and tone. Your doctor will give you instructions on how to care for your cast or splint.
Home treatment for minor symptoms
Home treatment may help relieve pain, swelling, and stiffness.
If your injury does not require an evaluation by a doctor, you may be able to use home treatment to help relieve pain, swelling, and stiffness. It may take up to 6 weeks or longer before your symptoms are gone. Use rest, ice, compression, and elevation (RICE) for home treatment.
- Rest and protect an injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
reduce pain and swelling. Apply
ice or cold packs immediately to prevent or minimize swelling. Apply the ice
or cold pack for 10 to 20 minutes, 3 or more times a day.
- For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
- After 48 to 72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility. Some experts recommend alternating between heat and cold treatments.
- Compression, or wrapping the injured or sore area with an elastic bandage (such as an Ace wrap), will help decrease swelling. Wear a sling for the first 48 hours after the injury, if it makes you more comfortable and supports your shoulder. If you feel you need to use a sling for more than 48 hours, discuss your symptoms with your doctor.
- Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
- Gently massage or rub the area to relieve pain and encourage blood flow. Do not massage the injured area if it causes pain.
- Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Smoking.
|Try a nonprescription medicine to help treat your fever or pain:|
Talk to your child’s doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
|Be sure to follow these safety tips when you use a nonprescription medicine:|
Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:
- Signs of infection or inflammation develop.
- Numbness, tingling, or cool, pale, skin develops.
- Shoulder range of motion or strength in the joint decreases or does not return to normal.
- Symptoms do not improve despite home treatment.
- Symptoms become more severe or frequent.
The following tips may prevent shoulder problems or injuries.
General prevention tips
- Stay in good overall physical shape. Strengthen your wrist, arm, shoulder, neck, and back muscles to help protect and decrease stress on your shoulder. Do stretching and range-of-motion (ROM) exercises for your arms and shoulders.
- Maintain good posture. Stand straight and relaxed, without slumping.
- Warm up well and stretch before any activity. Stretch after exercise to keep hot muscles from shortening and cramping.
- Wear protective gear during sports or recreational activities, such as roller-skating or soccer.
- Wear your seat belt when in a motor vehicle.
- Do not use alcohol or other drugs before participating in sports or when operating a motor vehicle or other equipment.
- Don't carry objects that are too heavy.
- Avoid catching falling objects.
- Use a step stool. Do not stand on chairs or other unsteady objects.
- Use the correct body movements or positions during activities, such as lifting, so that you do not strain your shoulder. Do not lift objects that are too heavy for you.
- Avoid overusing your arm doing repeated movements that can injure your bursa or tendons. In daily routines or hobbies, think about the activities in which you make repeated arm movements. Try alternating hands during activities such as gardening, cooking, or playing musical instruments. Use rest, ice, compression, and elevation (RICE) for home treatment.
- Avoid keeping your arms out to the side or raised overhead for long periods of time, such as when painting a ceiling. If you must do these things, take frequent breaks, and use RICE for home treatment.
- Consider consulting a sports-training specialist if you are a competitive or serious recreational athlete. The specialist can recommend training and conditioning programs to prevent shoulder problems or injuries.
- Make sure your child's backpack is the right size with good support. Carrying heavy backpacks may increase his or her risk of shoulder problems or injury.
- If you feel that activities at your workplace are causing pain or soreness from overuse, call your human resources department for information on alternative ways of doing your job or to discuss equipment modifications or other job assignments.
- To prevent falls in your home, remove raised doorway thresholds, throw rugs, and clutter. For more information, see Preventing Falls.
- To prevent falls in babies and toddlers, use stair gates to block stairways. Use gates at the top and bottom of the stairs, and use the gates properly. For more information, see tips to prevent falls in babies and toddlers.
Keep bones strong
- Eat a nutritious diet with enough calcium and vitamin D, which helps your body absorb calcium. Calcium is found in dairy products, such as milk, cheese, and yogurt; dark green, leafy vegetables, such as broccoli; and other foods. For more information, see the topic Healthy Eating.
- Exercise and stay active. Talk to your doctor about an exercise program that is right for you. Begin slowly, especially if you have been inactive. For more information, see the topic Fitness.
- Don't drink more than 2 alcoholic drinks a day if you are a man, or 1 alcoholic drink a day if you are a woman. People who drink more than this have a higher risk for weakening bones (osteoporosis). Alcohol use also increases your risk of injuries related to falls.
- Stop or do not start smoking. Smoking puts you at a much higher risk for developing osteoporosis. It also interferes with blood supply and healing. For more information, see the topic Quitting Smoking.
Shoulder injuries such as bruises, fractures, or dislocations may be caused by abuse. Suspect possible abuse when an injury cannot be explained or does not match the explanation, repeated injuries occur, or the explanations for the cause of the injury change. Seek help if:
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What are your main symptoms?
- How long have you had your symptoms?
- What were you doing when you first noticed your symptoms?
- Have you had this problem in the past? If so, do you know what caused the problem at that time? How was it treated?
- How and when did an injury occur? How was it treated?
- Have you ever had any injuries to the same area? Do you have any ongoing problems because of the previous injury?
- What activities related to sports, work, or your lifestyle, make your symptoms better or worse?
- Do you think that activities related to your job or hobbies caused your symptoms?
- What home treatment measures have you tried? Did they help?
- What prescription and nonprescription medicines have you taken? Did they help?
- Were illegal drugs or alcohol involved in your injury?
- Do you have any health risks?
If you have a shoulder problem, the following list of questions may help you and your doctor determine how much your shoulder and arm function has changed.
- Is your arm comfortable hanging at your side?
- Can you sleep on your affected side?
- Can you wash your back or opposite shoulder?
- Can you toss an object underhand?
- Can you toss an object overhand?
- Can you put your hand behind your head?
- Can you tuck in the back of your shirt?
- Can you carry 20 lb (9 kg) at your side, such as carrying a light suitcase?
- Can you put a 1 lb (0.5 kg) object up on a shelf at chest level or higher?
- Can you put an 8 lb (3.6 kg) object up on a shelf at chest level or higher?
|Author||Jan Nissl, RN, BS|
|Editor||Susan Van Houten, RN, BSN, MBA|
|Associate Editor||Tracy Landauer|
|Primary Medical Reviewer||Martin Gabica, MD - Family Medicine|
|Specialist Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Last Updated||September 19, 2009|
Last Updated: September 19, 2009
Author: Jan Nissl, RN, BS