SHOULDER STRAIN |
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General Information
DEFINITION--Injury to muscles or tendons that attach to bones in the shoulder. Muscles, tendons and bones comprise units. These units stabilize the shoulder and allows its motion. A strain occurs at a unit's weakest part. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Muscles and tendons that attach to bones in the shoulder.
Bones in the shoulder area, including the humerus, scapula and clavicle.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain when moving or stretching the shoulder.
Muscle spasm in the shoulder.
Swelling over the injury.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the shoulder muscle or tendon (visible with X-rays).
Inflammation of the tendon sheath.
CAUSES
Prolonged overuse of muscle-tendon units in the shoulder.
Single violent blow or force applied to the shoulder.
RISK INCREASES WITH
Contact sports such as boxing, wrestling or rugby.
"Throwing" sports, such as baseball, football, basketball or tennis.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous shoulder injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
Wear protective equipment, such as shoulder pads, for contact sports.
Avoid overuse. For example, rest between games if you are a pitcher or quarterback.
To prevent a recurrence, tape the shoulder area before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic shoulder following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones do. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
Wrap the injured shoulder with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injections of corticosteroids, such as triamcinolone, to reduce inflammation.
ACTIVITY
For a moderate or severe strain, use a sling for at least 72 hours.
Resume your normal activities gradually.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe shoulder strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
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