Shoulder Injury: Prevention, Treatment and Recovery

Shoulder injuries can arise from various causes, encompassing traumatic incidents, overuse, and degenerative changes. Traumatic injuries often result from falls, sports-related accidents, or direct blows to the shoulder, leading to dislocations, fractures, or soft tissue damage. Overuse injuries occur gradually and are commonly associated with repetitive overhead motions, as seen in activities like swimming, throwing, or weightlifting. Often people will wake up and experience shoulder pain in the morning. These repetitive motions can cause stress on the shoulder's structures, leading to conditions such as tendinitis, bursitis, or impingement. Additionally, degenerative changes with ageing, like osteoarthritis, can contribute to shoulder pain and dysfunction.

Types of Shoulder Injuries

1. Rotator cuff tears. The rotator cuff, a group of tendons and muscles surrounding the shoulder joint, can tear due to acute trauma or chronic wear and tear. This can result in pain, weakness, and limited range of motion.

2. Shoulder dislocation. A dislocation occurs when the upper arm bone (humerus) pops out of the shoulder socket. This often happens during falls or high-impact sports, causing intense pain and instability.

3. Fractures. Fractures can affect the clavicle (collarbone), humerus, or shoulder blade (scapula), commonly caused by falls, sports injuries, or accidents. Fractures may require immobilisation or surgical intervention.

4. Shoulder impingement. *This condition also known as Subacromial impingement involves the compression of tendons and bursa in the shoulder during arm elevation, leading to pain and inflammation. Overhead activities often exacerbate impingement.

5. Frozen shoulder. Characterised by stiffness, pain, and restricted movement, frozen shoulder typically develops gradually. The shoulder capsule thickens and tightens, limiting joint mobility.

6. Bursitis. inflammation of the bursa, fluid-filled sacs that cushion the shoulder joint, can occur due to repetitive motions or direct trauma. Bursitis results in pain and swelling.

7. Tendonitis. Inflammation of the tendons, commonly the biceps or rotator cuff tendons, can result from overuse or aging. This leads to pain, swelling, and impaired function.

8. AC joint separation. A separation of the acromioclavicular (AC) joint, often caused by a fall onto the shoulder, results in pain and a visible bump at the top of the shoulder.

9. Osteoarthritis. Degeneration of the shoulder joint's cartilage with aging can lead to osteoarthritis. This causes pain, stiffness, and reduced range of motion.

Understanding the causes and types of shoulder injuries is crucial for appropriate prevention strategies, early intervention, and effective management. Individuals experiencing persistent shoulder pain or dysfunction should seek medical advice for accurate diagnosis and tailored treatment plans.

How can I prevent injury?

Strengthening the shoulder muscles is the key to a stable shoulder joint, especially the rotator cuff muscles, four strapping muscles that attach the ball to the socket part of your shoulder joint. Make sure any upper body workouts are balanced – if you are strong at lifting in front of you, such as doing weighted biceps curls, make sure you work out the opposing muscle group, like the triceps and the muscles around the shoulder blade at the back.

Make sure you address flexibility. This can be as simple as changing position if you are working at your desk all day and doing some WFH stretches such as big arm swings, to ensuring that at the end of any work-out you stretch out the muscles in isometric (long-held) positions in every direction. It is also important to have an ergonomic work set-up.

Working on your core stability is crucial – these are the muscles around your stomach, including your sought-after six-pack but much deeper abdominal ones too, and the meaty muscles on either side of your spine. This helps with posture and protects you from many types of injury. It allows you to concentrate on sporting technique and ensures you don’t over-exert the shoulder joint.

You should attend the Emergency Department if you are in intense pain, if there has been a significant force applied to your shoulder, or if it looks in a funny shape or you are unable to move it. This may indicate a fracture or dislocation, or a complete tear of a muscle or tendon. If your shoulder is suddenly hot, red, and very sore on movement, you should attend the Emergency Department with urgency, as there may be an infection of the joint.

Do book a routine appointment with your doctor if you’ve had a shoulder injury for two weeks or more, and it’s not improving. Your doctor’s surgery may also suggest you can refer yourself directly to a physiotherapist or a musculoskeletal (MSK) service.

If you’ve injured your shoulder, a physiotherapist or sports doctor is best-placed to assess it. Depending on the type of injury, they may suggest imaging to take a closer look at the joint and assess any damage.

An X-ray will determine if there are bone fractures or a dislocation – useful in the Emergency Department, but it doesn’t tell you very much else. An ultrasound scan can assess the biceps tendon and rotator cuff muscles and is an inexpensive method that avoids any radiation, unlike X-rays or CT scans.

A CT scan will look in more detail at the bones and joints, which is useful if there has been trauma, but it can’t see much of the soft tissues. An MRI looks closely at the soft tissue, it may be better placed to see a bursitis or a tendon tear and it can determine deeper structures inside the shoulder joint, such as the labrum. While this can be useful to determine the source of pain or weakness, it is an expensive scan and there are limited places available.

As a general rule of thumb, you should move your shoulder as much as able – to the point of mild discomfort but not to the point of pain. Take painkillers such as paracetamol or ibuprofen as needed in the beginning stages after an injury, and so that you can gently move your shoulder. Cold packs may relieve pain in the first day or two, but heat packs will help sore muscles to recover in the longer term.

You can try some simple shoulder exercises to keep the joint supple initially. Ultimately you should aim to strengthen the shoulder muscles to protect the joint in future, but you may need expert advice on this, depending on your injury. Avoiding overexerting the shoulder with heavy lifting or twisting. Avoid any repetitive sports or tasks that may exacerbate it further – it needs a chance to rest and recover.

You also need to ensure that you nurture the muscles around the injury shoulder – stretching out the wrist and forearm, and the neck and upper back. These can become tense and are at risk of new injury themselves while compensating for a shoulder injury.