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 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, 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 it 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, 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, 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, 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, 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.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Major trauma is any event that can cause very serious injury, such as:
- A fall from more than 10 ft (3.1 m) [more than 5 ft (1.5 m) for children under 2 years and adults over 65].
- A car crash in which any vehicle involved was going more than 20 miles (32 km) per hour.
- Any event that causes severe bleeding that you cannot control.
- Any event forceful enough to badly break a bone.
When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood supply to the area. This can be serious.
There are other reasons for color and temperature changes. Bruises often look blue. A limb may turn blue or pale if you leave it in one position for too long, but its normal color returns after you move it. What you are looking for is a change in how the area looks (it turns blue or pale) and feels (it becomes cold to the touch), and this change does not go away.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
With severe bleeding, any of these may be true:
- Blood is pumping from the wound.
- The bleeding does not stop or slow down with pressure.
- Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may be true:
- The bleeding slows or stops with pressure but starts again if you remove the pressure.
- The blood may soak through a few bandages, but it is not fast or out of control.
With mild bleeding, any of these may be true:
- The bleeding stops on its own or with pressure.
- The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Symptoms of shock (most of which will be present) include:
- Passing out.
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.
Symptoms of shock in a child may include:
- Passing out.
- Being very sleepy or hard to wake up.
- Not responding when being touched or talked to.
- Breathing much faster than usual.
- Acting confused. The child may not know where he or she is.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
- Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
- Long-term alcohol and drug problems.
- Steroid medicines, which may be used to treat a variety of conditions.
- Chemotherapy and radiation therapy for cancer.
- Other medicines used to treat autoimmune disease.
- Medicines taken after organ transplant.
- Not having a spleen.
Symptoms of infection may include:
- Increased pain, swelling, warmth, or redness in or around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Symptoms of a heart attack may include:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness, tingling, or a strange feeling in your chest or other areas.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
- Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
- Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Pain in children 3 years and older
- Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
- Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
- Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
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 rings or bracelets. It may be difficult to remove the jewelry after swelling develops.
- 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.
- 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.
- 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.
- 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.
- 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
Call your doctor 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. Make sure children and teenagers use school bags and backpacks correctly.
- 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 the 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.
Keep your bones strong
- Eat healthy foods such as milk, cheese, yogurt, and dark green, leafy vegetables like broccoli. 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. Drinking alcohol increases your chances of having weak bones (osteoporosis). It also increases your chances of falling.
- Do not smoke or use other tobacco products. Smoking increases your chances of having osteoporosis. It also causes problems with the blood supply in your arms and slows healing. For more information, see the topic Quitting Smoking.
Shoulder injuries such as bruises, burns, fractures, cuts, or punctures 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. You may be able to prevent further abuse by reporting it and seeking help.
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?
|Primary Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Specialist Medical Reviewer||David Messenger, MD|
|Last Revised||May 16, 2013|
Last Revised: May 16, 2013
Author: Healthwise Staff
Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & David Messenger, MD
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