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Shoulder Pain / Shoulder Instability

A shoulder sprain or strain involves an injury to the soft tissues of the shoulder.    Sprains involve injury to ligaments (the bands of tissue that connect bones together) and strains refer to injuries of muscles and tendons.

What is a Shoulder Sprain/Strain?

A shoulder sprain or strain involves an injury to the soft tissues of the shoulder.    Sprains involve injury to ligaments (the bands of tissue that connect bones together) and strains refer to injuries of muscles and tendons.  Shoulder sprains occur in one of the joints that connect the four bones of the shoulder – the clavicle, sternum, scapula and acromion.  Severe sprains can cause shoulder separation.  Shoulder strains can be relatively minor or can result in a complete tear of muscle.


What causes a Shoulder Sprain/Strain?

Most shoulder sprains occur when the arm is unnaturally forced to twist, the arm twists suddenly or abruptly, an individual falls on an outstretched arm, or there is a severe direct blow or trauma to the arm, shoulder, or upper chest.  Shoulder sprains are common in individuals that engage in contact sports.  Shoulder strains can result from poor posture, keeping the arms elevated or in an awkward position for a prolonged period, a quick or sudden movement, and even stress.


What are the symptoms of a Shoulder Sprain/Strain?

Symptoms of shoulder sprains and strains may include limited mobility of the shoulder or pain with movement, pain and swelling around the shoulder, and possible tenderness, redness or bruising around the shoulder.  The location and severity of symptoms may differ depending on which joint or muscle in the shoulder is affected by the injury and the severity of the injury, which can be graded in three categories.


How is a Shoulder Sprain/Strain diagnosed?

A medical professional will take a complete medical history and will perform a physical exam.  Questions will be asked related to when the symptoms began, what activities caused the symptoms, what worsens or relieves symptoms, and the relative severity of symptoms.  Pressure will be placed on the areas of suspected injury to identify swelling, tenderness, bruising and pain.  Patients may be asked to perform certain movements to determine range of motion limitations, stability of the joint, and to identify what increases or decreases pain.  The injured shoulder will also be compared to the healthy shoulder.  X-rays may be ordered to rule out fractures or bone displacement.  Magnetic resonance imaging (MRI) or CT scan may be recommended to determine the extent of soft tissue damage.  In certain situations, an arthrogram may also be performed.


When should I seek care for a Shoulder Sprain/Strain?

If you fall on your arm or receive a blow to the shoulder that causes continued pain and swelling, or if you have pain, stiffness or limited mobility following any activity that does not improve with home treatments (rest, ice, over the counter medications), you should seek the advice of a medical professional.  If the injury is accompanied by an inability to move your arm or shoulder, or you think the shoulder is displaced, the joint feels “loose”, or a bone is fractured, you should seek immediate medical attention.


What will the treatment for a Shoulder Sprain/Strain
consist of?

Treatment for shoulder sprains and strains begins with resting the affected arm and shoulder (which may include immobilizing the area with a sling or brace) and applying ice for the first couple of days to reduce swelling and inflammation, as well as pain.  Nonsteroidal anti-inflammatory medications may also be taken to reduce pain and swelling.  Following a brief period of rest, physical therapy exercises and rehabilitation may begin, including exercises focused on building strength, flexibility and range of motion.  Electrical stimulation may also be used.  Shoulder strains may benefit from massage therapy as well as heat and cold therapy and strengthening and stretching exercises.  Return to regular activities may need to be gradually built up and a brace may need to be worn for awhile.  In severe sprains, where the shoulder is dislocated or the joint is displaced, or if a muscle strain is severe and the muscle is torn, surgery may be required.


Which muscle groups/joints are commonly affected by a Shoulder Sprain/Strain?

Shoulder sprains and strains affect the muscles and ligaments in the shoulder.  Injury can also affect movement of the arm.


What type of results should I expect from the treatment of a Shoulder Sprain/Strain?

Most patients with mild and moderate shoulder sprains and strains will improve in a matter of weeks or up to a few months.  Athletes involved in contact sports will have a high risk of re-injury so they may need to take a number of months off from their sport to fully rehabilitate the shoulder to avoid re-injury.  Whether you experience any lingering pain with activity, clicking sounds or any issues with joint instability long term will depend in part on the extent of the original injury and whether you return to previous activity levels too soon.

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