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Shoulder Problems and Injuries

Overview

Minor shoulder problems, such as sore muscles and aches and pains, are common. Shoulder problems develop from everyday wear and tear, overuse, or an injury. They can also be caused by the natural process of aging.

Your shoulder joints move every time you move your arms. To better understand shoulder problems and injuries, you may want to learn more about the shoulder joint itself. The shoulder is a ball-and-socket joint. It has three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or cause problems. The acromioclavicular (AC) joint, which lies over the top of the shoulder, is also easily injured.

Shoulder problems can be minor or serious. Symptoms may include pain, swelling, numbness, tingling, weakness, changes in temperature or color, and changes in your range of motion. Shoulder injuries most often occur during sports activities, work-related tasks, projects around the home, or falls. Home treatment often can help relieve minor aches and pains.

Sudden (acute) injury

Injuries are the most common cause of shoulder pain.

A sudden (acute) injury may occur from a fall on an outstretched arm, a direct blow to the shoulder, or abnormal twisting or bending of the shoulder. Pain may be sudden and severe. Bruising and swelling may occur soon after the injury. Sometimes nerves or blood vessels may be injured or pinched during the injury. In that case, the shoulder, arm, or hand may feel numb, tingly, weak, or cold, or it may look pale or blue. Acute injuries include:

  • Bruises (contusions). They occur when small blood vessels under the skin tear or rupture, often from a twist, bump, or fall. Blood leaks into tissues under the skin and causes a black-and-blue color that often turns purple, red, yellow, and green as the bruise heals.
  • Injuries to the tough, ropy fibers (ligaments) that connect bone to bone and help stabilize the shoulder joints (sprains).
  • Injuries to the tough, ropy fibers that connect muscle to bone (tendons).
  • Pulled muscles (strains).
  • Injuries to nerves, such as brachial plexus neuropathy.
  • Separation of the shoulder. This occurs when the outer end of the collarbone (clavicle) separates from the end (acromion) of the shoulder blade because of torn ligaments. This injury occurs most often from a blow to a shoulder or a fall onto a shoulder or outstretched hand or arm.
  • Damage to one or more of the four tendons that cover the shoulder joint (torn rotator cuff). This damage may occur from a direct blow to or overstretching of the tendon.
  • Broken bones (fractures). A break may occur when a bone is twisted, struck directly, or used to brace against a fall.
  • Pulling or pushing bones out of their normal position among the other bones that make up the shoulder joint (subluxation or dislocation).

Overuse injuries

You may not recall having a specific injury, especially if symptoms began slowly or during everyday activities. Overuse injuries occur when too much stress is placed on a joint or other tissue. This often happens when you overdo or repeat an activity. Overuse injuries include:

  • Inflammation of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, a tendon, or the skin. This inflammation is called bursitis.
  • Inflammation of the tough, ropy fibers that connect muscles to bones (tendinitis). Bicipital tendinitis is an inflammation of one of the tendons that attach the muscle (biceps) on the front of the upper arm bone (humerus) to the shoulder joint. The inflammation usually occurs along the groove (bicipital groove) where the tendon passes over the humerus to attach just above the shoulder joint.
  • Muscle strain.
  • A frozen shoulder. This is a condition that limits shoulder movement. It may follow an injury.
  • Overhead arm movements. They may cause tendons to rub or scrape against a part of the shoulder blade called the acromion. This rubbing or scraping may lead to abrasion or inflammation of the rotator cuff tendons. (This is also called impingement syndrome.)

Other causes of shoulder symptoms

Overuse and acute injuries are common causes of shoulder symptoms. Less common causes include:

  • Muscle tension or poor posture.
  • Pain that's coming from somewhere else in your body (referred shoulder pain).
  • Breakdown of the cartilage that protects and cushions the shoulder joints (osteoarthritis).
  • Calcium buildup in the tendons of the shoulder.
  • An irritated or pinched nerve or a herniated disc in the neck.
  • Infection in the skin (cellulitis), joint (infectious arthritis), bursa (septic bursitis), or bone (osteomyelitis).
  • Cancer that has spread to the bones of the shoulder or spine.
  • Abuse. Any shoulder injury (especially a dislocated shoulder) that can't be explained, doesn't match the explanation, or occurs more than once may be caused by abuse.

Treatment

Treatment for a shoulder injury may include first aid, physical therapy, and medicine. In some cases, surgery is needed. Treatment depends on:

  • The location and type of injury, and how bad it is.
  • How long ago the injury occurred.
  • Your age, health condition, and activities, such as work, sports, or hobbies.

Check Your Symptoms

Do you have a shoulder injury or other shoulder problem?
Yes
Shoulder problem or injury
No
Shoulder problem or injury
How old are you?
Less than 5 years
Less than 5 years
5 years or older
5 years or older
Are you male or female?
Male
Male
Female
Female

The medical assessment of symptoms is based on the body parts you have.

  • If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Have you had shoulder surgery in the past month?
If a cast, splint, or brace is causing the problem, follow the instructions you got about how to loosen it.
Yes
Shoulder surgery in the past month
No
Shoulder surgery in the past month
Could you be having symptoms of a heart attack?
If you're having a heart attack, there are several areas where you may feel pain or other symptoms.
Yes
Symptoms of heart attack
No
Symptoms of heart attack
Have you had a major trauma in the past 2 to 3 hours?
Yes
Major trauma in past 2 to 3 hours
No
Major trauma in past 2 to 3 hours
Do you have severe bleeding that has not slowed down with direct pressure?
Yes
Severe bleeding
No
Severe bleeding
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Have you had a shoulder injury in the past month?
Yes
Shoulder injury in the past month
No
Shoulder injury in the past month
Are you having trouble moving your shoulder?
Pain and swelling can limit movement.
Yes
Difficulty moving shoulder
No
Difficulty moving shoulder
Can you move the shoulder at all?
Yes
Able to move the shoulder
No
Unable to move the shoulder
Have you had trouble moving for more than 2 days?
Yes
Difficulty moving for more than 2 days
No
Difficulty moving for more than 2 days
Have you had numbness, tingling, or weakness in your arm, hand, or wrist for more than an hour?
Weakness is being unable to use the arm or hand normally no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.
Yes
Numbness, tingling, or weakness for more than 1 hour
No
Numbness, tingling, or weakness for more than 1 hour
Did the shoulder or collarbone get twisted out of shape or pop out of its normal position?
Yes
Shoulder was out of normal position
No
Shoulder was out of normal position
Is the shoulder back in place now?
Yes
Shoulder back in place
No
Shoulder back in place
Has the shoulder popped out of place before?
Yes
History of dislocation
No
History of dislocation
Has sudden, severe weakness or severe numbness affected the whole arm or the whole hand?
Weakness is being unable to use the arm or hand normally, no matter how hard you try. Pain or swelling may make it hard to move, but that is not the same as weakness.
Yes
Severe or sudden numbness or weakness in the whole arm or hand
No
Severe or sudden numbness or weakness in the whole arm or hand
Are you having trouble moving your shoulder?
Pain and swelling can limit movement.
Yes
Difficulty moving shoulder
No
Difficulty moving shoulder
Is it very hard to move or somewhat hard to move?
"Very hard" means you can't move it at all in any direction without causing severe pain. "Somewhat hard" means you can move it at least a little, though you may have some pain when you do it.
Very hard
Very hard to move
Somewhat hard
Somewhat hard to move
How long have you had trouble moving your shoulder?
Less than 2 days
Difficulty moving shoulder for less than 2 days
2 days to 2 weeks
Difficulty moving shoulder for 2 days to 2 weeks
More than 2 weeks
Difficulty moving shoulder for more than 2 weeks
Has the loss of movement been:
Getting worse?
Difficulty moving is getting worse
Staying about the same (not better or worse)?
Difficulty moving is unchanged
Getting better?
Difficulty moving is improving
Is the arm blue, very pale, or cold and different from the other arm?
If the arm is in a cast, splint, or brace, follow the instructions you got about how to loosen it.
Yes
Arm blue, very pale, or cold and different from other arm
No
Arm blue, very pale, or cold and different from other arm
Is there any pain in the shoulder?
Yes
Shoulder pain
No
Shoulder pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
5 to 10: Moderate to severe pain
Moderate to severe pain
1 to 4: Mild pain
Mild pain
Has the pain:
Gotten worse?
Pain is increasing
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is improving
Does your child seem to be protecting the arm or not using it normally?
Yes
Favoring arm or not using arm normally
No
Favoring arm or not using arm normally
Do you have any pain in your shoulder?
Yes
Shoulder pain
No
Shoulder pain
How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?
8 to 10: Severe pain
Severe pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
How long has the pain lasted?
Less than 2 full days (48 hours)
Pain less than 2 days
2 days to 2 weeks
Pain 2 days to 2 weeks
More than 2 weeks
Pain more than 2 weeks
Has the pain:
Gotten worse?
Pain is getting worse
Stayed about the same (not better or worse)?
Pain is unchanged
Gotten better?
Pain is getting better
Do you think that the shoulder problem may have been caused by abuse?
Yes
Shoulder problem may have been caused by abuse
No
Shoulder problem may have been caused by abuse
Do you think the problem may be causing a fever?
Some bone and joint problems can cause a fever.
Yes
Possible fever
No
Possible fever
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
"Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
Yes
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
No
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
How long have you had problems with the shoulder?
Less than 1 week
Symptoms for less than 1 week
1 to 2 weeks
Symptoms for 1 to 2 weeks
More than 2 weeks
Symptoms for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

When an area turns blue, very pale, or cold, it can mean that there has been a sudden change in the blood supply to the area. This can be serious.

There are other reasons for color and temperature changes. Bruises often look blue. A limb may turn blue or pale if you leave it in one position for too long, but its normal color returns after you move it. What you are looking for is a change in how the area looks (it turns blue or pale) and feels (it becomes cold to the touch), and this change does not go away.

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Major trauma is any event that can cause very serious injury, such as:

  • A fall from more than 10 ft (3.1 m)[more than 5 ft (1.5 m) for children under 2 years and adults over 65].
  • A car crash in which any vehicle involved was going more than 20 miles (32 km) per hour.
  • Any event that causes severe bleeding that you cannot control.
  • Any event forceful enough to badly break a large bone (like an arm bone or leg bone).

With severe bleeding, any of these may be true:

  • Blood is pumping from the wound.
  • The bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

  • The bleeding slows or stops with pressure but starts again if you remove the pressure.
  • The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

  • The bleeding stops on its own or with pressure.
  • The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Pain in children 3 years and older

  • Severe pain (8 to 10): The pain is so bad that the child can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain. No one can tolerate severe pain for more than a few hours.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt the child's normal activities and sleep, but the child can tolerate it for hours or days.
  • Mild pain (1 to 4): The child notices and may complain of the pain, but it is not bad enough to disrupt his or her sleep or activities.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

  • Passing out (losing consciousness).
  • Feeling very dizzy or lightheaded, like you may pass out.
  • Feeling very weak or having trouble standing.
  • Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

  • Passing out (losing consciousness).
  • Being very sleepy or hard to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused. The child may not know where he or she is.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Postoperative Problems

Self-Care

First aid for a possible broken bone

Most minor shoulder problems will heal on their own, and home treatment is usually all that's needed. But if you think that you might have a more severe problem, use first aid until you can be seen by a doctor.

  • Control bleeding with direct pressure to the wound.
  • Remove all rings or bracelets. It may be hard to remove the jewelry after swelling starts.
  • Use a sling to support an injured shoulder.
  • If a bone is sticking out of the skin, don't try to push it back into the skin. Cover the area with a clean bandage.

Minor shoulder problem or injury

Try the following tips to help relieve shoulder pain, swelling, and stiffness.

  • Rest.

    It's important to rest and protect the affected area. Stop, change, or take a break from any activity that may be causing your pain or soreness.

  • Use ice.

    Ice will reduce pain and swelling. Apply ice or cold packs right away to prevent or reduce swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day.

  • Elevate the affected area.

    Try to keep the area at or above the level of your heart to help reduce swelling. Prop up the area on pillows while you apply ice and anytime you sit or lie down.

  • Wear a sling.

    For 48 hours, wear a sling if it makes you more comfortable and supports your shoulder.

  • Avoid things that might increase swelling.

    For 48 hours, avoid things that might increase swelling. These things include hot showers, hot tubs, hot packs, and drinks that contain alcohol.

  • Apply heat.

    After 48 to 72 hours, if swelling is gone, apply heat. You can start gentle exercise with the aid of moist heat to help restore and keep flexibility. Some experts advise switching between heat and cold treatments.

  • Rub the area.

    Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the affected area if it causes pain.

  • Move your arm.

    Try bending forward at the waist and let your affected arm hang straight down. Move your hips and legs, and let that motion gently swing your arm back and forth.

  • Don't smoke or use other tobacco products.

    Smoking slows healing because it decreases blood supply and delays tissue repair.

If you need to use a sling for more than 48 hours, you may have a more serious injury that needs to be checked by a doctor.

Signs of possible abuse

Most injuries are not caused by abuse. But bruises are often the first sign of possible abuse. Suspect physical abuse of a child or vulnerable adult when:

  • Any injury cannot be explained or does not match the explanation.
  • Repeated injuries occur.
  • Explanations change for how the injury happened.

You may be able to prevent further injuries by reporting abuse. Seek help if:

  • You suspect child abuse or elder abuse. Call your local child or adult protective agency, police, or a health professional, such as a doctor, nurse, or counselor.
  • You or someone you know is a victim of intimate partner violence (IPV).
  • You have trouble controlling your anger with a child or other person in your care.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

  • New or worse pain or swelling.
  • New signs of infection, such as redness, warmth, pus, or a fever.
  • New or worse numbness, tingling, or cool and pale skin.
  • Movement or strength decreases.
  • Symptoms occur more often or are more severe.

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Credits

Current as of: March 9, 2022

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine