Shoulder Pain

Shoulder injuries can be either acute (sudden onset) or chronic (gradual onset). Sudden onset shoulder injuries usually occur either through direct impact or trauma such as a dislocation or from over stretching or twisting as in a rotator cuff strain. Acute shoulder injuries can become chronic if they are not diagnosed and treated properly. We explain how to recognise and treat shoulder injuries as well as emergency first aid and when to see medical advice.

First aid for shoulder injuries

All acute and chronic shoulder injuries should be treated using the P.R.I.C.E. therapy principles of protection, rest, ice, compression, and elevation. This should be applied at home for at least the first 2 - 3 days.

Shoulder assessment

In order to thoroughly assess any injury, a sound knowledge of the anatomy of the area is required. This enables localised pain to be related to the surrounding structures and muscle injuries to be suspected from painful movements.

Sudden onset or acute shoulder injuries are ones which happen suddenly, often through a fall onto an outstretched arm or through direct impact, over stretching or overloading. Often the athlete will feel a sudden sharp pain with discomfort and/or loss of mobility. Sometimes there will be swelling and inflammation. It is important acute shoulder injuries are treated as soon as possible with the PRICE princples of immediate first aid. Always seek medical advice if pain is severe or you are in any doubt.

Rotator cuff strain

Rotator Cuff TearA rotator cuff strain is a tear to any of the four rotator cuff muscles in the shoulder. It is common in throwing and racket sports. Rotator cuff tears can range from mild to severe. Treatment consists of reducing pain and inflammation followed by a full rehabilitation program which includes mobility and strengthening as well as sports specific exercises. Read more on treatment of rotator cuff injuries.

Dislocated shoulder dislocated shoulder is a traumatic and painful injury often caused in contact sports or from a fall and urgent medical advice should be sought immediately. The upper arm bone dislocates out of its normal position in the shoulder joint causing significant damage to the soft tissues. A full rehabilitation program is essential if the athlete is to avoid re-injuring the shoulder. Read more about discloated shoulder.

AC Joint Sprain

AC Joint SeparationAn AC joint separation or sprain is an injury to the ligaments that hold the acromioclavicular joint at the top of the shoulder. It is usually caused by fall onto an outstretched arm. AC joint injuries range from very mild (grade 1) to a very severe (grade 6). Immediate first aid and treatment is essentail to avoid long term problems and deformity. Read more on AC joint sprain treatment including taping.

Clavical fracture

Clavicle FractureA clavicle fracture or broken collar bone as it is also known is a fracture of the clavicle bone which runs along the front of the shoulder to the breast bone or sternum in the middle of the chest. It will usually have happened as a result of a fall onto the shoulder or outstretched arm. The main symptom is pain along the collar bone which may be quite severe. There could be swelling over the area and a bony deformity may be felt. Read more on broken collar bone.

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Gradual onset shoulder pain or chronic shoulder pain may come on over a period of time. The athlete may not have known the exact time of injury which could have been niggling away for a while as they train through it. Due to the complexity of the shoulder joint, there are some injuries which may appear to have happened suddenly but also may develop gradually over time. A chronic shoulder injury may also be acutely painful.

Most common chronic shoulder injuries

Frozen shoulder

Adhesive capsulitis is the medical term for this condition which results in gradual onset pain and restricted movement in the shoulder joint. There are three phases that the patient will pass through; a freezing phase where 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.

Rotator cuff tendinopathy

Rotator cuff tendonitis or tendinopathy is a degenerative condition causing pain and stiffness in the shoulder. I can affect one or more of the rotator cuff tendons. Symptoms will come on gradually through overuse or may be the result of an acute rotator cuff strain which has not healed properly. Read more on rotator cuff tendinopathy.

Subacromial bursitis

Subacromial bursitis has similar symptoms to Supraspinatus tendinitis and rotator cuff tendinopathy with pain over a 60 degree arc when the arm is lifted out sideways. In this case it is the bursa which is a small sac of fluid which helps lubricate the tendon which is inflamed, rather than the tendon itself, although both can occur at the same time. Read more on subacromial bursitis.

Glenoid labrum tear

The glenoid labrum is a ring of tissue around the edge of the shoulder joint which attaches to the rim of the shallow hole or socket of the shoulder where the ball of the humerus sits. Symptoms include shoulder pain which cannot be localized to a specific point and is made worse by overhead activities. It can come on gradually through wear and tear but can also occur suddenly through trauma or twisting of the shoulder joint. Read more on glenoid labrum tears.

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