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Shouldering the Pain


Common Shoulder Injuries

Some of the most common shoulder injuries and their descriptions are listed below.

  1. Arthritis. Arthritis usually starts underneath the arc of bone covering the shoulder joint. It can develop in the ball-and-socket part of the shoulder over time. Bone spurs on the underside of this bone often irritate the rotator cuff causing tendinitis and eventually a rotator cuff tear. Arthritis is characterized by pain and crunching noises. Treatment usually consists of icing, range of motion and correction of movement imbalances. Activity or movement changes might be necessary.
  2. Tendinitis. This usually occurs in the rotator cuff or the bicep tendon as it crosses over the top of the arm bone. Tendinitis can become progressively worse and eventually lead to a rotator cuff tear. It can result from either acute or chronic injuries and is characterized by pain when lifting or bringing the arm across the front of the body. Treatment should consist of addressing movement imbalances, removing the cause of irritation, icing and other therapeutic treatments, like ASTYM or ultrasound. Activity or movement changes might be necessary.
  3. Separated shoulder. This is an injury to the joint between the shoulder blade and the collarbone.  Separated shoulder is caused by an acute injury, usually a fall directly onto the shoulder or on an outstretched hand. It is characterized by pain with shoulder movement away from the body and the appearance of a knot or lump on the top of the shoulder. No damage is done to the actual ball-and-socket part of the joint. Treatment is avoidance of pain-causing movements. Immobilization with a sling can be recommended in severe cases. Gradual return to activity is permissible as the pain subsides.
  4. Dislocated shoulder. This is a disruption of the ball-and-socket where the upper arm bone (ball) is removed from the socket. Dislocated shoulder is caused by a high-force acute injury such as a fall or overstretching of the arm overhead or behind the head. Chronic dislocations can occur in individuals who have had an acute dislocation or have general joint looseness in the shoulders. It is characterized by loss of the rounded appearance of the shoulder and severe pain. Immobilization is needed for 3-6 weeks directly following the injury. In severe cases, surgery might be needed to tighten the ligaments that hold the shoulder in place. Therapy for strengthening, pain, range of motion and return to activity can be needed depending on the activity needs and goals of the patient.
  5. Subluxation. Subluxation (sometimes called a partial dislocation) is similar to a dislocation, and is usually triggered repeatedly by putting the hand behind the head or overhead. A subluxing shoulder can be caused by an acute incident or repeated strain from activities like throwing, swimming or other high-speed overhead activities. It is characterized by the feeling of the joint slipping out of place, pain and inability to perform normal overhead or throwing activities. Treatment can include strengthening of the rotator cuff to hold the joint in place, activity or movement modification by a therapist, or possibly surgery in severe cases.
  6. Labral tear. The cartilage that surrounds the socket of the shoulder joint is called the labrum. A tear in the cartilage can result from being pulled on by the bicep tendon that attaches to it or by being pinched. It can also be injured from a dislocation. Diagnosis of a labral tear is usually done through an MRI or CT scan. Popping, pain with movements overhead and a feeling of joint instability are common symptoms. The treatment is often surgery to repair the structure followed by rehabilitation for range of motion, strengthening of the surrounding structures and activity and movement modifications.

To help keep your shoulders healthy, the following exercises illustrated in the attached document can be done as few as 2-3 times a week and up to 5-6 times a week.

  • Reverse arm slides stretch muscles that allow the shoulder blades to move properly.
  • Posterior shoulder stretches keep the muscles on the back of the shoulders flexible.
  • Bicep stretches keep the bicep muscles on the front of the shoulders flexible.
  • Empty can lifts strengthen the rotator cuff.
  • Lying arm lifts strengthen the muscles between the shoulder blades that support the shoulder joints.
  • Diagonal rubber tubing pulls strengthen all the important muscles of the shoulder area.

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