Rotator cuff injuries
AC Joint Sprain
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If you are not sure what your injury is why not check out our symptom checker! Or use the links below to view specific shoulder injuries.
- Frozen shoulder
- Winged scapula
- Shoulder tendonitis
- Rotator cuff tendonitis
- Subacromial bursitis
- Shoulder impingement syndrome
- Glenoid labrum tear
- Supraspinatus inflammation
- Subscapularis inflammation
- Pectoralis major tendon inflammation
- Referred shoulder pain
- Long head of the biceps tendinopathy
- Suprascapular neuropathy
- Proximal humerus growth plate fracture
- Clavicle tendonitis
- Dislocated shoulder
- Broken collar bone (Clavicle fracture)
- AC Joint separation
- Glenoid labrum tear
- Long head of biceps rupture
- Supraspinatus rupture
- Fracture of the neck of humerus
- Pec major tendon strain
- Sternoclavicular sprain
- Proximal humerus growth plate fracture
- Scapula fracture
- Shoulder sprain
- Posterior shoulder dislocation
- Deltoid muscle strain
- Rotator cuff tear
- Deltoid contusion
- Shoulder subluxation
The 5 most common causes of shoulder pain
Shoulder injuries can be either acute or chronic depending on when they are diagnosed and how long the pain/disability has been felt for. An acute shoulder injury occurs suddenly either through direct impact, over stretching a muscle, tendon or ligament, overusing a muscle or tendon or twisting of the shoulder joint.
The shoulder joint is particularly susceptible to injury because the is a very large range of movement that can occur at this joint and relatively small joint surfaces (in comparison to hip or knee). This means that the joint itself is much less stable and therefore requires a number of strong muscles, tendons and ligaments to enhance the stability. The following conditions are the most common causes of shoulder pain:
Rotator cuff strain
A rotator cuff injury is damage or overuse of one or more, or the muscles and tendons around the shoulder joint, known as the rotator cuff muscles. They are so called because their job is to rotate the arm at the shoulder and provide a supportive cuff around the joint.
Read more on rotator cuff strains
Glenoid labrum tear
The glenoid labrum is a ring of tissue which attaches to the rim of the shoulder socket where the ball of the humerus or arm bone sits. Symptoms include pain in the shoulder joint which can often not be localized to a specific point. It is usually caused by repetitive overhead throwing, lifting or catching heavy objects below shoulder height or falling onto an outstretched arm.
Read more on glenoid labrum tear
Shoulder instability occurs when the humerus (upper arm bone) pops out of the shoulder joint. There is a milder version of this injury called a subluxation where the humerus only partially comes out of the joint and pops back in immediately. The first time that a dislocation occurs it can cause severe shoulder pain and therefore requires professional medical attention to put the bone (“relocate”) back into the joint. Never attempt to put it back in (reduction) yourself as you can cause serious and permanent damage to the joint surfaces or more importantly the nerves in the arm. Dislocations of the shoulder often reoccur and lead to log term instability which is only addressed through surgery.
Read more on dislocated shoulder
AC joint injury
An AC joint injury is may also be referred to as 'shoulder separation' or AC joint sprain and should not be confused with a shoulder dislocation. It is usually caused by a fall onto an outstretched arm or through direct trauma in contact sports. Symptoms may include pain in the shoulder, specifically pain at where the collar bone meets the shoulder. As a result, you may be able to feel a lump or bump on the top of the shoulder joint depending on how bad the injury is.
Read more on AC joint sprain
Known as adhesive capsulitis, it is a painful condition resulting from chronic stiffness of the shoulder joint. A frozen shoulder goes through three phases; a freezing phase where shoulder pain is common and the joint tightens up, a stiff phase where the movement in the shoulder is significantly reduced and a thawing phase where the pain gradually reduces and mobility increases.
Read more on frozen shoulder
When Should I See a Doctor?
The majority of shoulder injuries, especially the minor ones can be treated at home. However, if you have any of the following symptoms you should seek further medical assistance.
- Severe pain in or around the shoulder and unable to move the shoulder after 24 hours.
- Severe swelling (oedema) around the injured area.
- An audible “pop” or “crack” in the shoulder joint area.
- A feeling when the arm comes out of the shoulder joint (dislocates).
- Altered sensation in the hand or arm – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia) in the hand.
- Unable to complete your normal daily activities after the initial 72 hours.
Further medical assistance can be sought through either your local GP or a private clinician such as a physiotherapist, sports therapist, osteopath or chiropractor.
In the first instance, if you have followed the P.R.I.C.E. principles (see below) and are still unable to move the arm at all after 24 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment. Also, if your shoulder “popped out” (dislocated), feels loose (“unstable”) or locks (unable to move the shoulder due to extreme pain) then you should consult your doctor or visit A&E.
Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your shoulder, you are highly recommended to seek advice from a specialist expert - such as a physiotherapist, sports therapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.
Immediate First Aid for Shoulder Injuries
All acute and chronic shoulder injuries should be treated using the P.R.I.C.E. therapy principle. This should be applied at home for at least the first 2 - 3 days. P.R.I.C.E. stands for Protection, Rest, Ice, Compression and Elevation.
Protection - Protect the shoulder injury from further damage. Where applicable, use of a arm sling or shoulder support is recommended.
- Rest - Refrain from using the arm/shoulder.
- Ice - The topical application of ice or cold therapy to the area of the shoulder can assist in reducing the symptoms of pain and inflammation.
- Compression - The use of a compression support to the shoulder can can help reduce swelling.
- Elevation - Keeping the hand elevated above heart level whenever possible to help reduce swelling in the hand due to the effects of gravity. This is best achieved using an upper arm sling.
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is using a support or splint.
In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.
If an injury is sustained during sporting activity some athletes have a tendency to 'run it off' or continue using the injured area. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases this is not true and is not advisable.
Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.
The application of ice to an injury, in the acute phase can substantially decrease the extent of the damage. It achieves this in a number of different ways:
- Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
- Reduces shoulder pain (pain gate theory)
- Reduces muscle spasm
- Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collar bone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression support which is elasticated and simply fits around the shoulder.
Elevation of the hand is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid (oedema) away from the hand that is distal to the injury site (shoulder).
Anatomy of the shoulder is comprised of the shoulder joint and the shoulder girdle. The shoulder joint, also known as the glenohumeral joint is a ball and socket joint made up of the ball or end of the humerus bone which sits in the socket of the shoulder. The shoulder girdle is made up of the scapular (shoulder blade), clavile (collar bone).
Read more on shoulder anatomy