The shoulder is a complex joint that can move in multiple directions and carry significant loads. But its versatility can put it under stress and make it prone to injury. We need to look after it to prevent any injury, but still enable it to carry out requirements for sports and work. Let’s talk you through the steps you can take to prevent shoulder injury. We’ll also outline any investigations used to assess injury, and techniques to aid recovery.
Strengthening the shoulder muscles is the key to a stable shoulder joint, especially the rotator cuff muscles, four strapping muscles that attach the ball to the socket part of your shoulder joint. Make sure any upper body workouts are balanced – if you are strong at lifting in front of you, such as doing weighted biceps curls, make sure you work out the opposing muscle group, like the triceps and the muscles around the shoulder blade at the back. Make sure you address flexibility. This can be as simple as changing position if you are working at your desk all day and doing some big arm swings, to ensuring that at the end of any work-out you stretch out the muscles in isometric (long-held) positions in every direction. Working on your core stability is crucial – these are the muscles around your stomach, including your sought-after six-pack but much deeper abdominal ones too, and the meaty muscles on either side of your spine. This helps with posture and protects you from many types of injury. It allows you to concentrate on sporting technique and ensures you don’t over-exert the shoulder joint.
You should attend the Emergency Department if you are in intense pain, if there has been a significant force applied to your shoulder, or if it looks in a funny shape or you are unable to move it. This may indicate a fracture or dislocation, or a complete tear of a muscle or tendon. If your shoulder is suddenly hot, red, and very sore on movement, you should attend the Emergency Department with urgency, as there may be an infection of the joint. Do book a routine appointment with your doctor if you’ve had a shoulder injury for two weeks or more, and it’s not improving. Your doctor’s surgery may also suggest you can refer yourself directly to a physiotherapist or a musculoskeletal (MSK) service.
If you’ve injured your shoulder, a physiotherapist or sports doctor is best-placed to assess it. Depending on the type of injury, they may suggest imaging to take a closer look at the joint and assess any damage. An X-ray will determine if there are bone fractures or a dislocation – useful in the Emergency Department, but it doesn’t tell you very much else. An ultrasound scan can assess the biceps tendon and rotator cuff muscles and is an inexpensive method that avoids any radiation, unlike X-rays or CT scans. A CT scan will look in more detail at the bones and joints, which is useful if there has been trauma, but it can’t see much of the soft tissues. An MRI looks closely at the soft tissue, it may be better placed to see a bursitis or a tendon tear and it can determine deeper structures inside the shoulder joint, such as the labrum. While this can be useful to determine the source of pain or weakness, it is an expensive scan and there are limited places available.
As a general rule of thumb, you should move your shoulder as much as able – to the point of mild discomfort but not to the point of pain. Take painkillers such as paracetamol or ibuprofen as needed in the beginning stages after an injury, and so that you can gently move your shoulder. Cold packs may relieve pain in the first day or two, but heat packs will help sore muscles to recover in the longer term. You can try some simple shoulder exercises to keep the joint supple initially. Ultimately you should aim to strengthen the shoulder muscles to protect the joint in future, but you may need expert advice on this, depending on your injury. Avoiding overexerting the shoulder with heavy lifting or twisting. Avoid any repetitive sports or tasks that may exacerbate it further – it needs a chance to rest and recover. You also need to ensure that you nurture the muscles around the injury shoulder – stretching out the wrist and forearm, and the neck and upper back. These can become tense and are at risk of new injury themselves while compensating for a shoulder injury.