Treating an Injured Shoulder

Relieving the Pain

Shoulder injuries need a sling to rest the shoulder, anti-inflammatory medication such as Ibuprofen every six hours, and ice where it hurts for 20 minutes out of each hour.  A bag of frozen peas will work fine, but a gallon Zip-lock freezer bag partially filled with a solution that is 1/2 water and 1/2 rubbing alcohol works better.  Fill the bag no more than about 1 inch thick when laying flat.

Types of Injuries

Your shoulder is basically two joints in one: the joint between the collar bone and the shoulder blade (the Acromioclavicular joint) and the joint between the shoulder blade and the arm bone (the gleno-humeral joint).

The ACROMIOCLAVICULAR (AC) JOINT is on the top of the shoulder.  It is usually damaged by a direct blow to the outside top of the shoulder, which tears the ligaments and joint capsule.  How much is torn determines the severity and treatment of the injury.  Sometimes it is necessary to inject the AC joint with cortisone to relieve chronic irritation. More serious injuries require surgical repair.

The GLENO-HUMERAL JOINT (the shoulder joint proper) can be injured suddenly or over time, or a combination of the two.

A DISLOCATION is one of those sudden injuries that is dramatic and painful and requires immediate medical attention to slip the joint back into place.  Subluxations (see more info below) are partial dislocations that slip back into place on their own.  Both require X-ray and orthopedic evaluation.  Definitive treatment for both is surgical, but it can be postponed if necessary or desirable.

Sudden, or acute ROTATOR CUFF tears are painful, and you know something just broke or tore loose.  Often they are caused by an up-and-back vigorous movement such as starting a chain saw.  The extent of the tear can vary from very small to complete detachment with retraction.  The treatment depends on the extent of the tear, your age, whether it’s your dominant arm or not, what activities you want to do, how much time you can do without the use of the arm while it heals, and your general health. Surgery is the definitive treatment (depending on the above factors), but a combination of physical therapy, proper exercises, and anti-inflammatory medication often solves the problem.  Occasionally, cortisone injections are used. Rotator cuff tears that occur over time are generally smaller, and occur in older individuals.

Other Gleno-humeral injuries that occur over time include:

SYNOVITIS is inflammation of the joint lining, called synovium.  It can occur for no good reason, or because of overuse of some sort.  It is treated with anti-inflammatory medications such as Aleve or Advil, and physical therapy.  It can be slow to respond, but usually resolves eventually.

BURSITIS is inflammation of the bursa that lies over the top of the rotator cuff, under the top bone of the shoulder joint, the acromion.  It is irritated if it is pinched between the acromion and the rotator cuff by using your arm above your shoulder height.  Usually it takes prolonged use to irritate the bursa, but the older you are, the shorter the time required.  This condition usually responds to anti-inflammatory medication such as Advil or Aleve, plus physical therapy and proper exercises.  Sometimes cortisone injections are needed.

SUBLUXATIONS are partial dislocations.  If caused over time, they are usually the result of repeating the same up and back motion of the arm.  Examples are throwing a baseball, and the free arm of a rodeo bronc or bull rider. Over time the front of the shoulder stretches out, and the top of the arm bone begins to slip out of the front of the joint.  If the activity continues, the stretching continues, and the subluxations (partial dislocations) displace more and more, resulting in accelerating pain.  The only two choices are a brace that restricts raising the arm, or surgical repair and stabilization.