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Treatment of shoulder strain or sprain – Most shoulder strains or sprains can be treated with nonsurgical treatments. Nonsurgical treatments could include:

Rest Sling Ice Anti-inflammatory medication Physical therapy and rehabilitation — your physician may order physical therapy to strengthen the shoulder and improve the range of motion. Electrotherapy treatments — ultrasound or laser treatments that can help to reduce pain and inflammation. PRP therapy — PRP therapy takes a patient’s blood and puts it through a centrifugation process to make the platelets more concentrated and then injected back into the patient in the affected area to accelerate healing.

Should you stretch a sprained shoulder?

A common myth is that shoulder problems occur from overuse. Turns out, the shoulder thrives with use. The majority of shoulder pain is triggered by capsulitis, which is an inflammation of the joint capsule that causes feelings of stiffness and pain in the shoulder joint.

• Shoulder pain that is not caused by a dislocation or arthritis begins as a tight shoulder.
• When the shoulder hurts, it is common for people to stop using it in a normal manner out of concern of causing more damage.
• However, once a person stops using his shoulder in a normal manner, it tightens up because it is the everyday use of joints that keeps them loose.

“The solution is stretching,” says Dr. Edward Weldon, an orthopedic surgeon at Straub Medical Center. “When you start to feel pain in your shoulder, make sure you regain your flexibility by gently stretching throughout the day,” Weldon says. “This concept is important it has to be done gently five times a day, throughout the day.” A stiff shoulder is a painful shoulder, and stretching allows for motion and relieves stiffness.

Complete the stiff shoulder stretches five times a day, doing five repetitions of each stretch. Hold the stretch for at least 30 seconds. Repeat every two to three hours.

For more stretching suggestions, watch the videos below, or visit our YouTube channel, Dr. Weldon assists Barry with an internal rotation stretch that can help alleviate shoulder pain. Dr. Weldon assists Marcus with a simple stretching program that can help alleviate capsulitis in the shoulder.

Dr. Weldon assists Jackie with a stretching routine that can alleviate capsulitis in throwing athletes. Remember: If stretching causes pain that lasts longer than 15 minutes, stretch more gently to avoid injury. “These particular stretches are not the only stretches you can do, but this is the solution that works in my practice when done wisely,” Weldon says.

“Getting people to do this stretching routine is hard, but we have a great group of physical therapists at the Straub Bone & Joint Center who understand this cycle and understand how to get people to stretch.” Straub’s multi-disciplinary bone and joint team provides expert care that spans surgical and non-surgical treatments and rehabilitation services.

How long does shoulder sprain last?

Recovery from shoulder strain or sprain – For a mild to moderate shoulder sprain or strain, you may be able to return to your normal activities within one to two weeks. Moderate sprains or strains may take as long as six to eight weeks before you can resume day-to-day shoulder activities.

What are red flags for shoulder pain?

Examination – See the separate article for further information. There are over 100 specific ‘Orthopaedic Special Tests’ to detect shoulder pathology but few are sensitive or specific enough to be diagnostically discriminatory,

• Examine the neck, axilla and chest wall.
• Examine the cervical spine and assess range of motion.
• Inspect from the front, side, and behind for muscle wasting, swelling and deformity, or for bruising.
• Palpate the sternoclavicular, acromioclavicular and glenohumeral joints. Look for tenderness, swelling, warmth and crepitus.
• As an initial screening test, ask the person to place the palms of their hands at the base of the neck with elbows pointing laterally and then to put their arms down and try to put the back of the hands between the shoulder blades. However, be aware that this also involves joints other than the shoulder (ie elbow, wrist).
• Assess the power, stability and range of motion (active, passive and resisted) in both shoulders.
• Look for a painful arc (pain between 70-120° of abduction).
• Test passive external rotation (reduced in ‘frozen shoulder’). With the elbow held into the side, turn the arm outwards as far as possible.
• Perform the ‘drop arm test’: passively abduct the patient’s shoulder. Then ask the patient to lower the abducted arm slowly to the waist. This can identify a massive rotator cuff tear. They may be able to lower the arm slowly to 90° because this uses mostly the deltoid muscle but, below 90°, the arm will drop to the side.
• Perform the ‘cross-arm test’: this isolates the acromioclavicular joint. Ask the patient to raise the arm to 90° straight in front of them. Then ask the patient to adduct the arm across the chest. If there is an acromioclavicular joint problem, there will be pain in the area of the joint.

• Blood tests including, and radiology such as CXR are generally only necessary if there are ‘red flag’ symptoms/signs,
• Ultrasonography is the preferred imaging test for the shoulder.
• Plain X-rays rarely help except to confirm shoulder dislocation and shoulder arthritis,
• Magnetic resonance arthrogram is useful in shoulder instability,
• If referred neck pain is suspected then cervical spine X-rays may be helpful but the diagnosis is usually clinical.

See also the separate article, There is a lack of well-designed clinical trials in the management of shoulder disorders. Management in primary care is usually conservative: reduce or avoid overhead activities; attention to any contributing factors; medication for pain relief, including corticosteroid injection.

• Rotator cuff disorders:
  • Advise modification of activities, including reducing precipitating movements (eg, reaching overhead).
  • Offer analgesia; paracetamol with or without codeine, or an oral non-steroidal anti-inflammatory drug (NSAID).
  • Refer to physiotherapy with the goal of optimising shoulder function, using an evidence-based rehabilitation protocol,
  • Consider a subacromial corticosteroid injection if the person has limited function because of pain and is therefore unable to perform strengthening and stabilising exercises. They may be of short-term benefit when used alone, See the separate article.
  • Do not give a corticosteroid injection if:
    • The person has previously received a corticosteroid injection from an experienced practitioner with minimal or no benefit.
    • The person has already had three or more injections in the same shoulder in the previous year.
    • There is a suspected significant rotator cuff tear.
    • There is any contra-indication to corticosteroid injection (eg, infection, ).
  • Evidence shows that physiotherapy and steroid injections may be equally helpful in the short term, Injections may be repeated if the initial response is good.
• Rotator cuff tears :
  • Physiotherapy and steroid injections may be helpful for minor tears.
  • Suspected large tears that are symptomatic may benefit from early referral for orthopaedic input.
  • Surgical treatment usually involves arthroscopic rotator cuff tendon repair.
• Calcific tendonitis :
  • When calcific tendonitis is symptomatic, it may present as chronic, relatively mild pain in the shoulder, with sporadic episodes of severe, acute pain radiating down the arm or to the neck.
  • The calcium deposits cause a chemical irritant inflammatory reaction. There is also an increase in pressure in the tendon, which is turn leads to malfunction of the rotator cuff and subacromial pain.
  • Treatment for calcific tendonitis includes NSAIDs, corticosteroids, physiotherapy, aspiration or lavage. For patients refractory to these treatments, open or arthroscopic shoulder surgery may be offered to excise the deposit.
  • Extracorporeal shock wave lithotripsy is no longer recommended by the National Institute for Health and Care Excellence (NICE).
• Glenohumeral disorders: see the separate article,

Glucocorticoid injection appears to be more effective in the short term than physiotherapy and exercises,

• Acromioclavicular disease (see the separate ):
  • Acromioclavicular injury usually responds to rest and simple analgesia, unless there is significant disruption of the joint, in which case orthopaedic referral is necessary,
  • Consider providing a sling for 5-7 days if an acromioclavicular joint injury is suspected.
  • Consider referring to physiotherapy after 4-6 weeks if the person responds poorly to rest and analgesia.
• Degeneration of the humeral head :
• The humeral head may degenerate as a result of a range of conditions – eg, osteoarthritis, or avascular necrosis. The whole or only part of the articular surface of the humeral head may be affected.
• Conservative treatment includes physiotherapy, pain relief, topical or oral NSAIDs and corticosteroid injections.
• Patients who do not respond to conservative treatments may need surgery, which involves either shoulder arthroplasty using a stemmed humeral head prosthesis, or fusion of the joint.
• Shoulder resurfacing arthroplasty replaces only the damaged joint surfaces, with minimal bone resection and is recommended by NICE as a surgical option.
• Muscle strains:
• Muscle strains of the shoulder are very common, including trapezius and rhomboid strains.
• Treatment of muscle strains includes rest, ice/heat, compression and elevation (sitting up) as well as massage, non-steroidal anti-inflammatory drugs (topical or oral) and further analgesia as required.
• Severe or persistent strains may require physiotherapy.

There is no good-quality evidence to say whether acupuncture works to treat shoulder pain of any cause or if it is harmful, Emergency same day assessment if:

• Suspected joint infection (red skin, fever or systemically unwell).
• Unreduced dislocation (trauma, epileptic fit or electric shock leading to abnormal shoulder shape and loss of rotation).
• Acute trauma, depending on clinical judgement.

Urgent if any red flags are identified:

• Trauma, pain and weakness, or sudden loss of ability to actively raise the arm (with or without trauma): suspect acute rotator cuff tear.
• Any shoulder mass or swelling: suspect malignancy.
• Red skin, painful joint, fever or the person is systemically unwell: suspect septic arthritis.
• Trauma leading to loss of rotation and abnormal shape: possible shoulder dislocation.
• New symptoms of inflammation in several joints: suspect inflammatory arthritis.

Consider urgent investigations and/or referral to secondary care if:

• Systemic symptoms – eg, fever, night sweats, weight loss or new respiratory symptoms.
• Undiagnosed severe shoulder pain or severe restriction of movement.
• History of trauma and the person is seen acutely.

Urgent referral for suspected:

• Malignancy (past history of cancer, symptoms or signs of cancer, mass or swelling, unexplained deformity, lymphadenopathy). Follow the two-week referral pathway.
• Acute rotator cuff tear caused by trauma (trauma, pain and weakness).
• Inflammatory arthritis.
• Neurological lesion (unexplained wasting, significant motor or sensory deficit). Discuss with neurology, neurosurgery or orthopaedics.

Refer early to secondary care if:

• Recurrent shoulder instability.
• Severe post-traumatic pain.
• Pain is having a significant impact – eg, work or sport activities.

Refer if pain and function are not improving following conservative treatment for three months. Consider referral to a specialised musculoskeletal clinic – for example, for provision of physiotherapy or corticosteroid injection.

• The prognosis of chronic shoulder pain depends on the underlying cause.
• Increasing age, female sex, symptoms of gradual onset, prolonged symptoms, severe or recurrent symptoms and associated neck pain are associated with a worse outcome,
• Recovery in shoulder pain is generally slow. Studies have shown complete recovery at one month in 23% of patients and at 18 months in 59% of patients.

; Wheeless’ Textbook of Orthopaedics

1. ; Shoulder and Elbow Information, ShoulderDoc
2. ; Shoulder pain: diagnosis and management in primary care. BMJ.2005 Nov 12331(7525):1124-8.
3. ; Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle us-guided percutaneous treatment-nonrandomized controlled trial. Radiology.2009 Jul252(1):157-64. doi: 10.1148/radiol.2521081816.
4. ; NICE CKS, April 2017 (UK access only)
5. ; Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med.2008 Feb42(2):80-92
6. ; Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician.2008 Feb 1577(4):453-60.
7. ; Chronic shoulder pain: part II. Treatment. Am Fam Physician.2008 Feb 1577(4):493-7.
8. ; Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg.2009 Jan-Feb18(1):138-60. doi: 10.1016/j.jse.2008.06.004. Epub 2008 Oct 2.
9. ; Interventions for shoulder pain. Cochrane Database Syst Rev.2000(2):CD001156.
10. ; Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev.2004(1):CD002758.
11. ; Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev.2014 Aug 268:CD011275. doi: 10.1002/14651858.CD011275.
12. ; Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg.2009 Apr17(4):207-19.
13. ; NICE Interventional Procedure Guidance, July 2010
14. ; Acupuncture for shoulder pain. Cochrane Database Syst Rev.2005 Apr 18(2):CD005319.

: Shoulder Pain (Causes, Assessment, and Treatment)

Can you make a sprained shoulder worse?

Putting off treatment will only make the problem worse, and it can lead to worse damage, more pain, and maybe even chronic issues. It’s always better to play it safe. Going to the doctor for minor injuries is better than ignoring injuries that could turn into serious medical problems later on down the road.

How long should you rest with a pulled shoulder?

How to ease shoulder pain yourself – It can take four to six weeks to recover fully from mild shoulder pain. There are some things you should and shouldn’t do to help ease shoulder pain. Do

stay active and gently move your shoulder try shoulder pain exercises – do them for six to eight weeks to stop pain returning stand up straight with your shoulders gently back sit with a cushion behind your lower back rest your arm on a cushion in your lap use pain relief so you can keep moving – try painkillers like paracetamol and ibuprofen and heat or cold packs if you injure your shoulder, try a pack of frozen peas in a tea towel for five minutes, three times a day to reduce bruising of soft tissues if the pain starts more gradually, try a hot water bottle in a tea towel for 20 minutes, two to three times a day to ease the pain

You usually need to do these things for two weeks before shoulder pain starts to ease. Do not:

completely stop using your shoulder – this can stop it getting better do things that seem to make it worse make up your own strenuous exercises or use heavy gym equipment slouch when sitting – don’t roll your shoulders or bring your neck forward

Can a shoulder strain get worse?

Just because you don’t notice any swelling or bruising doesn’t mean something isn’t wrong. You might have a minor sprain, and if you don’t take care of it now, it will only get worse.