Shoulders

Topic 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 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 dislocation) that cannot be explained, does not match the explanation, or occurs repeatedly may be caused by abuse.

Be-Your-Own Therapist Home Treatment

Treatments for Shoulder Pain

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.

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. 

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.

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.

Ice will 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. 

Symptoms to Watch For During Home Treatment

Call your doctor or visit the hospital if any of the following symptoms 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.


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