Common Injuries of the Shoulder
Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower,
we rely heavily on our shoulders to perform a number of activities.
Normally, the shoulder has a wide range of motion, making it the most mobile joint
in the body. Because of this flexibility, however, it is not very stable and is easily
The shoulder is made up of two main bones: the end of upper arm bone (humerus) and
the shoulder blade (scapula). The end of the humerus is round and fits into a socket
in the scapula. Surrounding the shoulder is a bag of muscles and ligaments. Ligaments
connect the bones of the shoulders, and tendons connect the bones to surrounding muscle.
To keep shoulders healthy and pain-free, it's important to know how to spot and avoid
Shoulder instability happens most often in young people and athletes. When muscles
and ligaments that hold it together are stretched beyond their normal limits, the
shoulder becomes unstable. For younger people, this condition may be a normal part
of growth and development. Shoulders often stiffen or tighten with age.
In athletes, shoulder instability is caused by certain motions used in tackling or
pitching, for example. These motions put great force on the shoulder, stretching the
shoulder ligaments over time. It can cause pain that comes on either quickly or over
time, a feeling that the shoulder is loose, or a weakness in the arm. Treatment includes
rest, physical therapy or surgery.
A shoulder separation, or sprain, happens when the ligaments that hold the clavicle
to the roof of the shoulder tear. If this happens, the clavicle is pushed out of place
and forms a bump at the top of the shoulder. Sprains often happen during a fall, when
your hand or arm is outstretched to stop the fall, or when you fall on a hard surface.
When the sprain happens, it causes severe pain, a misshapen shoulder, and decreased
shoulder movement. Treatment depends on the severity of the sprain. To help decrease
pain and swelling, apply ice right after the injury. Keeping the arm in a sling to
limit the movement of the shoulder lets ligaments to heal. This is followed by physical
therapy exercises. Sometimes, surgery is needed.
If the ligaments holding the shoulder muscles to bones tear and can't hold the joint
together, the shoulder is dislocated. Falling onto an outstretched hand, arm or the
shoulder itself, or a violent twisting, can cause a shoulder dislocation. The main
symptom is pain in the shoulder that becomes worse with movement. To treat a dislocation,
apply ice right after the injury to decrease pain, swelling and bleeding around the
joint. Within 15 to 30 minutes of the injury, the joint will be painful and swollen.
A dislocated shoulder needs urgent medical care. Healthcare providers treat dislocations
by using gentle traction to pull the shoulder back into place. When the shoulder pops
out of the socket repeatedly, it’s called recurrent instability. Recurrent instability
can be treated with surgery to repair the torn ligaments.
Rotator cuff tear
The rotator cuff is a group of four muscles of the upper arm. They allow you to raise
and rotate the arm. The muscles are attached to the bones by tendons. The tendons
of the rotator cuff allow the muscles to move the arm. If the tendons tear, the humerus
can't move as easily in the socket. This makes it hard to move the arm up or away
from the body.
As people age and are less active, tendons start to degenerate and lose strength.
This weakening can lead to a rotator cuff tear. Most rotator cuff injuries happen
to middle-aged or older adults who already have shoulder problems. They can happen
in younger people too. The shoulder has a poor blood supply. This makes it harder
for the tendons to repair and maintain themselves. Using your arm overhead puts pressure
on the rotator cuff tendons. Repetitive movement or stress to these tendons can lead
to impingement. This is when the tissue or bone in that area becomes misaligned and
rubs or chafes.
The rotator cuff tendons can be injured or torn by trying to lift a very heavy object
with an extended arm. It can also happen from falling, or by trying to catch a heavy
Symptoms of a torn rotator cuff include tenderness and soreness in the shoulder when
using the shoulder. If the tendon has ruptured, you may not be able to raise the arm
at all. It may be hard to sleep lying on that side. You may feel pain when pressure
is put on the shoulder.
Treatment depends on the severity of the injury. If the tear is not complete, your
healthcare provider may suggest RICE, for Rest, Ice, Compression, and Elevation. Resting
the shoulder is probably the most important part of treatment. But, after the pain
has eased, you will need to start physical therapy to regain shoulder movement. Your healthcare
provider may prescribe a nonsteroidal anti-inflammatory drug (NSAID) for pain.
This extreme stiffness in the shoulder can happen at any age. It affects about 2%
of Americans, most often between 40 and 60 years of age. But the causes are not fully
understood. Frozen shoulder can affect people with diabetes, thyroid disease, heart
disease, or Parkinson disease. It can also happen if the shoulder has been immobile
for a period of time. It happens when a minor shoulder injury heals with scar tissue
that affects how the joint moves. This scar tissue reduces flexibility in the shoulder
and makes it more prone to injury. The main symptom is the not being able to move
the shoulder in any direction without pain. Treatment can be NSAIDs, cortisone shots,
or physical therapy. You can reduce further injury and stiffness by stretching before
A sudden increase in activity can place great stress on the shoulders and lead to
a loss of flexibility. This is a common problem in middle age, especially among people
who don't exercise regularly, but go out every now and then for an intense sport.
Although painful and inconvenient, overuse problems can often be treated with rest,
NSAIDs and stretching exercises.
Starting as early as age 50, some people get osteoarthritis, which causes painful
movement. This happens as the smooth surfaces of the cartilage that line the bones
of the shoulder joint are worn away, and joints start to wear out and become larger.
The most common cause of osteoarthritis is overuse. Treatments for arthritis in the
shoulder depend on the severity of pain. The usual treatments are rest, NSAIDs, and
cortisone shots. In some cases, a replacement of the shoulder joint is needed.