Shoulder Injury

Symptoms

DEFINITION

• Injuries to a bone, muscle, joint or ligament in the shoulder

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Types of Shoulder Injuries

• Fractures (broken bones)
• Dislocations (bone out of joint)
• Sprains - stretches and tears of ligaments
• Strains - stretches and tears of muscles (e.g., pulled muscle)
• Muscle overuse injuries from sports or exercise (e.g., strain, bursitis, tendonitis)
• Muscle bruise from a direct blow (e.g., contusion)
• Causes extrinsic to shoulder (referred pain) - Examples include neck pain, cardiac disease, abdominal disorders, spleen injury

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See More Appropriate Topic (instead of this one) If

• ANIMAL BITE to shoulder
• BURN of shoulder
• PUNCTURE WOUND to shoulder
• SKIN INJURY is main concern

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FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it (Reason: removal could increase bleeding).

FIRST AID Advice for Shock: Lie down with feet elevated.

FIRST AID Advice for Suspected Fracture or Dislocation of the Shoulder:

• Use a sling to support the arm. Make the sling with a triangular piece of cloth.
• Or, at the very least, the patient can support the injured arm with the other hand or a pillow.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Major bleeding (actively dripping or spurting) that can't be stopped
• Amputation or bone sticking through the skin

Call Your Doctor Now (night or day) If

• You think you have a serious injury
• Injury looks like a broken bone or dislocated joint (crooked or deformed)
• Can't move injured shoulder at all
• Collar bone is painful or tender to touch
• Severe pain

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Can't move injured shoulder normally (e.g., full range of motion, able to touch top of head)
• There is a large swelling or bruise (wider than 2 inches) at the site of the injury
• You are over age 54, have osteoporosis, or use steroid medications routinely

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Injury interferes with work or school
• Pain has not improved after 3 days
• Injury is still painful or swollen after 2 weeks

Self Care at Home If

• Minor shoulder injury and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR MINOR SHOULDER INJURY

1. Treatment of a Bruise (e.g., direct blow to shoulder):
   • Apply a cold pack or an ice pack (wrapped in a moist towel) to the area with ice for 20 minutes each hour for 4 consecutive hours (i.e., 20 minutes of cooling followed by 40 minutes of rest for 4 hours in a row).
   • Rest the injured part as much as possible for 48 hours.
   • 48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
2. Treatment of Sprains and Strains:
   • FIRST AID - Apply an ice pack (crushed ice in a plastic bag covered with a moist towel) to reduce bleeding, swelling, and pain.
   • Continue to apply crushed ICE packs for 10-20 minutes every hour for the first 4 hours. Then apply ice for 10-20 minutes 4 times a day for the first 2 days.
   • REST the injured shoulder for 24 hours. You may return to normal activity after 24 hours of rest if the activity does not cause pain.
3. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
4. Expected Course: Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 2 weeks to completely resolve.
5. Call Your Doctor If:
   • Pain becomes severe
   • Pain does not improve after 3 days
   • Pain or swelling lasts more than 2 weeks
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

Bruise on Shoulder (4 Days Old)

This bruise is four days old.

Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.

Bruise on Forearm

Small minor bruise (contusion) on forearm.

First Aid - Bleeding Arm

• Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth.

 First Aid - R.I.C.E.

RICE is an acronym for how to take care of a sprain, strain, or bruise. There are four things you should do:

• REST the injured part of your body for 24 hours. Can return to normal activity after 24 hours of rest if the activity does not cause severe pain.
• Continue to apply crushed ICE packs for 10-20 minutes every hour for the first 4 hours. Then apply ice for 10-20 minutes 4 times a day for the first two days.
• Apply COMPRESSION by wrapping the injured part with a snug, elastic bandage for 48 hours. If numbness, tingling, or increased pain occurs in the injured part, the bandage may be too tight. Loosen the bandage wrap.
• Keep the injured part of the body ELEVATED and at rest for 24 hours. For example, for an injured ankle, place that leg up on a pillow and stay off the feet as much as possible.

X-Ray - Clavicle Fracture

The x-ray shows a collar bone (clavicle) fracture in a 9 year old who fell off his bicycle.

X-Ray - Shoulder Dislocation

This 24 year old male was playing soccer and fell injurying his right arm.

The x-ray shows that the round end of the humerus is completely out (dislocated) from the shoulder joint.

 X-Ray - Normal Clavicle

X-Ray - Normal Shoulder

First Aid - Sling - How to Put On

To put on a sling you first need to have a triangular bandage. Many first aid kits have a triangular bandage.

• Find the two ends of the triangle that are farthest apart. These are the ends that you will tie around the neck.
• Lay the arm down the middle of the triangle.
• Take the two ends of the triangle that are farthest apart and tie them behind the neck. (a square knot is best, but any knot will do).

First Aid - Splint for Wrist Injury

• Immobilize the hand and wrist by placing them on a rigid splint (see drawing).
• Tie several cloth strips around hand/wrist to keep the splint in place. You can use a roll of gauze or tape instead of cloth strips.

Notes:

• You can make a splint from: a wooden board, magazine folded in half, folded-up newspaper, cardboard, or a pillow.
• If you have no splinting materials, then support the injured arm by resting it on a pillow or folded up blanket.
• After putting on the splint, apply a cold pack or an ice pack (wrapped in a towel) to the area.

Source: LMS Inc.

Copyright 2000-2009. Self Care Decisions, LLC. Used by Permission.