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 do a number of activities.
Normally, the shoulder has a wide range of motion, making it the most mobile joint
in the body. But because of this flexibility, it's not very stable and is easily injured.
The shoulder is made up of two main bones: the end of the 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 group of muscles and ligaments. Ligaments
connect the bones of the shoulders. 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 health problem 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 gradually,
a feeling that the shoulder is loose, or a weakness in the arm. Treatment includes
rest, physical therapy, or surgery.
A shoulder (or acromioclavicular) separation, or sprain, happens when the ligaments
that hold the clavicle to the acromion tear. If this happens, the clavicle is pushed
out of place and may form 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 ease pain and swelling, apply ice right after the injury. Keeping
the arm in a sling to limit the movement of the shoulder lets ligaments heal. This
is often followed by physical therapy exercises. Sometimes, surgery is needed.
If the ligaments holding the shoulder 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 ease 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 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 fix 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 fix 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 (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). These help ease
pain and swelling. NSAIDs are the most common medicines used. Medicines may be prescribed
or bought over the counter. They may be given as pills. Or they may be put on the
skin as a gel, cream, or patch.
This extreme stiffness in the shoulder can happen at any age. It affects about 1 in
50 Americans, most often between ages 40 and 60. 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 can happen 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 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 starting
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. 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.