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by LaRusso L

Shoulder Sprain

Definition

A shoulder sprain is stretching or tearing of the ligaments that stabilize the shoulder. Ligaments are strong bands of tissue that cross joints and connect bones to each other.
Capsule of Glenohumeral Joint
Shoulder Joint Capsule
Copyright © Nucleus Medical Media, Inc.

Causes

Shoulder sprains may be caused by:
  • Falling on an outstretched arm
  • Forced twisting of the arm
  • A blow to the shoulder
  • Overuse or repetitive movement of the shoulder joint

Risk Factors

Factors that may increase your risk of a shoulder sprain include:
  • Playing sports, such as swimming, volleyball, baseball, gymnastics, and tennis
  • Occupations that involve:
    • Repetitive shoulder movements, including heavy lifting
    • Lifting at or above the height of your shoulder
    • Vibration of the shoulder
    • Irregular posture or movements
  • Poor coordination
  • Poor balance
  • Inadequate flexibility and strength in muscles and ligaments
  • Loose joints or connective tissue disorders

Symptoms

Shoulder sprain may cause:
  • Pain, tenderness, and swelling around the shoulder
  • Redness, warmth, or bruising around the shoulder
  • Limited ability to move the shoulder and increased pain with movement

Diagnosis

The doctor will ask about your symptoms and how you injured your shoulder. The doctor will examine your shoulder to assess the stability of the joint and the severity of the injury.
Tests may include:
Shoulder sprains are graded according to their severity:
  • Grade 1—Some stretching with micro-tearing of ligament tissue.
  • Grade 2—Partial tearing of ligament tissue.
  • Grade 3—Complete tearing of ligament tissue.

Treatment

Treatment includes:

Acute Care

Rest
Your shoulder will need time to heal. Avoid activities that cause pain or put extra stress on your shoulder.
Cold
Apply an ice or a cold pack to the area for 15-20 minutes several times a day after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.
Pain Relief Medications
To manage pain, your doctor may recommend:
  • Over-the-counter medication, such as aspirin, ibuprofen, or acetaminophen
  • Topical pain medication—creams or patches that are applied to the skin
  • Prescription pain relievers
Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.

Recovery

Extra support may be needed to help protect, support, and keep your shoulder in line while it heals. Supportive steps may include:
  • Brace or sling—You may need to wear a brace to keep your shoulder still as it heals. Do not return to activities or sports until your doctor gives you permission to do so.
  • Rehabilitation exercises—Begin exercises to restore flexibility, range of motion, and strength in your shoulder as recommended by your doctor or physical therapist.
  • Surgery—Surgery is rarely needed to repair a mild shoulder sprain without instability or dysfunction. However, in athletes earlier surgery may be considered to avoid recurrent injury.

Prevention

Shoulder sprains may not always be preventable. There are steps you can take to reduce your chance of getting a shoulder sprain. These include:
  • Wearing protective equipment and using proper technique while playing sports.
  • Keep shoulders, back, and chest strong with regular exercises to absorb the energy of sudden physical stress

RESOURCES

American Academy of Orthopaedic Surgeons
http://www.orthoinfo.org
American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Benjamin HJ, Hang BT. Common Acute Upper Extremity Injuries In Sports. Clinical Pediatric Emergency Medicine. 2007;8(1):15-30.
DeLee and Drez's Orthopaedic Sports Medicine. 2nd ed. Ch. 21. Philadelphia; Elsevier; 2003.
Micheo WF, Ramos E. Frontera: Essentials of Physical Medicine and Rehabilitation. 1st ed. Ch. 15. Philadelphia; Hanley and Belfus; 2002.
Shoulder problems. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Shoulder%5FProblems/default.asp. Updated May 2010. Accessed September 11, 2013.
Shoulder separation. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00033. Updated October 2007. Accessed September 11, 2013.
Shoulder strain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated November 19, 2012. Accessed September 11, 2013.
Sports Injuries: Basic Principles of Prevention and Care . Blackwell Scientific Publications; 1993.
1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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