Shoulder Sprains and Strains
What is a shoulder sprain?
A person with a shoulder sprain has stretched or torn a
ligament in the shoulder. Ligaments are strong bands of
tissue that hold the bones together in a joint during
movement. A force that bends or twists the shoulder beyond
the normal range of motion causes a shoulder sprain. The
most common cause of shoulder sprain is a sports injury.
Shoulder sprains are the most common type of shoulder
What Causes Shoulder Sprains?
- Falling on an outstretched arm
- Forced twisting of the arm
- A blow to the shoulder
Symptoms of a shoulder sprain or strain:
- Shoulder pain:
- Shoulder pain is worse with movement
- Shoulder tenderness
- Shoulder swelling
- Arm weakness (unilateral):
- Arm pain
- Shoulder pain may radiate into the arm
Diagnosing Shoulder Strains and Sprains:
The doctor will inspect both your shoulders, comparing
your injured shoulder with your uninjured one. The doctor
will note any swelling, shape differences, abrasions or
bruising and will check for extra motion in the
acromioclavicular and sternoclavicular joints. He or she
will test your ability to move your shoulder, and will ask
about arm pain. Your doctor will gently press and feel your
acromioclavicular joint, sternoclavicular joint and
Because many important blood vessels and nerves travel
through your shoulder area, the doctor will also check the
pulses at your wrist and elbow and will check the muscle
strength and skin feeling in your arm, hand and fingers.
If your physical examination suggests that you have a
severe shoulder sprain or fractured bone in the shoulder
area, your doctor will order X-rays. In more severe
acromioclavicular joint injuries, your doctor may also order
magnetic resonance imaging (MRI) scans or computed
tomography (CT) scans.
Shoulder Sprain Surgery
In most cases, conservative treatment is recommended to
resolve painful symptoms unless a rupture of the affected
ligament, muscle, or tendon is present and results in
significant shoulder instability or weakness.
Grade I and II shoulder sprains and strains are initially
treated with rest, cold therapy, and nonsteroidal
anti-inflammatory drugs (NSAIDs) to help reduce painful
symptoms. A sling may be used for the first few days
following injury to allow symptoms of acute pain to subside;
however, prolonged use of a sling may lead to shoulder
stiffness and slowed recovery time. Early range of motion
exercises should be performed as tolerated to promote
healing and reduce the risk of a frozen shoulder (adhesive
capsulitis). Whereas grade I injuries will typically heal
with conservative treatment, grade II injuries may also
require physical therapy to improve range of motion and
promote muscle strengthening.
Grade III shoulder sprains and strains may be initially
treated with a sling and cold therapy, but many cases may
require surgery to repair the ruptured ligament, muscle, or
tendon. Acromioclavicular dislocations and grade III strains
in older individuals are typically treated conservatively
unless the individual engages in heavy overhead work or is
very active. However, muscles and tendons that have
sustained full thickness tears often require surgery to trim
torn muscle or tendon fibers (débridement), to reattach the
ruptured muscle or tendon, or to repair torn or detached
cartilage (labral tear and SLAP lesion).
Surgical repair of the shoulder muscles, tendons, or
cartilage may be performed arthroscopically through tiny
incisions using a fiberoptic scope and small instruments, or
with open surgery to reconstruct larger, more complicated,
or avulsed tears with grade III injury. A mini-incision
between 4 cm to 6 cm long also may be used to access and
repair torn soft tissues in certain individuals, promoting
reduced healing time. Upper arm and shoulder surgery may be
performed with either a regional or general anesthesia.
Following surgery, rehabilitation is important to help the
individual regain functional strength and mobility.