Common Shoulder Injuries and Their Treatment

by Brick Campbell, MD and Patrick O'Connell, MD

Common Shoulder Injuries and Their Treatment

Our arms are asked to carry a significant burden every single day. We use our upper extremities to perform repetitive tasks from the fun activities of catch or volleyball on the beach to the mundane chores of folding laundry. All this consistent activity leads to the stress of our shoulders.

Our shoulders can also be injured more directly in an accident, such as falling on an outstretched arm. With this risk and the chronic stress our shoulders receive on a daily basis, it is no surprise that shoulder injuries are extremely common.

Eight million people per year end up in a doctor’s office for a shoulder -related problem. Almost 10% of all high school athlete injuries are to the shoulder, and according to the Bureau of Labor Statistics, almost 10% of all work-related injuries are also to the shoulder.

What are some common shoulder injuries?

Acute shoulder injuries

Acute shoulder injuries are sudden and severe. They happen instantaneously and should be treated immediately.

Shoulder dislocation

Shoulder dislocation occurs when the upper arm bone comes out of the shoulder blade socket and is often caused by falling onto an outstretched arm. Medical attention needs to be sought out right away.

Symptoms

  • Out-of-place shoulder.
  • Pain.
  • Swelling.
  • Inability to raise affected arm.

Treatment

  • Moving the bone in place.
  • Splinting the arm.
  • Physical therapy.

Surgery may be required in rare cases.

Rotator cuff tear

The tissue that connects the upper arm bone to the shoulder muscles can be torn. An acute rotator cuff tear can occur during a shoulder dislocation for example.

Symptoms

  • Pain and weakness.
  • Swelling.
  • Inability to lift the arm.

Treatment

  • Rest.
  • Physical therapy.
  • Steroid injections
  • Possibly surgery.

You need to seek medical attention immediately. If you are a resident of Virginia, Ortho On Call is a great option for urgent, no-appointment-needed orthopedic care.

Fractures of the collarbone

A collarbone fracture is a common injury that can occur from traumatic events such as falling off your bicycle. You will feel swelling and pain in the area and will be unable to lift your arm up.

Treatment

Surgical treatment needs to happen immediately. The longer you wait to be treated, the less successful treatment will be.

In the 80’s and 90’s, the medical literature we had at our disposal suggested nonsurgical treatment for clavicle fractures. Today however, the current literature supports surgery. If the collarbone is displaced and is not corrected surgically, the patient’s shoulder will “shorten,” causing the motions of the shoulder to be on the incorrect plane leading to recurrent shoulder pain, weakness, and a diminished range of motion.

Chronic shoulder injuries

Chronic shoulder injuries develop from abuse due to repetitive motion and occur over an extended period of time.

Recurrent instability

If someone has had several shoulder dislocations, then they are at risk of developing recurrent instability, an overuse condition where the lining of the shoulder joint becomes stretched out. The ball of the shoulder joint becomes less securely fastened and will completely or partially come out of the socket.

Treatment

Physical therapy can be employed to strengthen the muscles surrounding the shoulder and to restore range of motion.


Surgery may be required if instability still occurs after completion of physical therapy.   

Rotator cuff disease

Rotator cuff disease is a general term describing the wearing out of the rotator cuff over time. Patients do not have a singular traumatic episode they can recall that caused the ensuing pain. It can vary from tendonitis to partial or full tearing of the rotator cuff.

Symptoms

  • Pain in the shoulder.
  • Decreased ability to lift objects.
  • Diminished strength.
  • Difficulty sleeping at night.

Treatment

  • Physical therapy.
  • Activity modification.
  • Steroid injections to decrease inflammation.
  • Surgery such as a rotator cuff repair which can now be arthroscopically.

Arthritis in the shoulder

Arthritis in the shoulder such as acromioclavicular arthritis, which is arthritis in the small joint on the top of the shoulder, is extremely common, and the pain can often be tolerated by patients. However, arthritis in the genohumeral joint, or the ball and socket joint, can be extremely painful.

Symptoms

  • Diminished range of motion.
  • Decreased strength.
  • Decreased function.
  • Difficulty sleeping at night.

Treatment options to manage symptoms

  • Medications such as anti-inflammatories.
  • Physical therapy.
  • Steroid injections.

The above treatment options will not correct the issue, but they can offer significant symptom relief. If more conservative treatment options do not substantially relieve pain, shoulder replacement surgery is a treatment option that has outstanding success rates.  

Frequently asked questions

Is acupuncture recommended for shoulder pain relief?

We’re big believers in if it works, it works.

Acupuncture is designed to fit into a pre-ordained network of nerves, and acupuncturists try to stimulate or decrease the stimulation of those nerves to help relieve pain. A therapy technique similar to acupuncture is dry needling. Dry needling involves breaking up muscle tension and muscle scarring to help muscles work better and relieve pain the affected area.

Is platelet-rich-plasma (PRP) therapy a good treatment option?

Platelet-rich-plasma therapy is a technique where we draw some of your own blood, and then we spin it down in a centrifuge. The result is a layer that contains platelet-rich plasma and growth factors, which can be used to stimulate a healing response in a number of issues.

This type of therapy is still being researched, and there is no clear-cut answer on its total effectiveness. There are some studies that support the benefit of PRP therapy for tendon problems, but it has not been found to help treat the rotator cuff.

Can rotator cuff pain radiate in the hands and fingers?

Typically, rotator cuff problems will cause the onset of pain in the shoulder and can radiate down the middle of the arm or elbow. It is not common for pain to travel all the way to the fingers. That’s not to say that it couldn’t be related, but we would first want to rule out any other potential issues such as a neurologic cervical condition in the neck.

What is the approximate recovery time after a shoulder replacement?

Recovery time depends on your health status. There are shoulder replacements being done in outpatient clinics, but the more standard protocol is for a patient to stay overnight, receive a little bit of therapy in the morning, and get readjusted before heading home.

Then, you have to protect the shoulder for about six weeks while the subscapularis or the implant entryway to the shoulder heals. Once that has healed, you can be much more aggressive in terms of getting your range of motion and strength back.

Pain relief is very immediate. Many patients wake up and are amazed that the pain that was keeping them up at night has already subsided.