Shoulder Injury: How to Tell What You Have Done

First aid for a shoulder injury

1. Stop the activity and support the arm against your body. A sling, or a folded scarf or towel, takes the weight off the shoulder.
2. Do not try to push a dislocated shoulder back in yourself or let untrained people try. You can damage nerves, blood vessels or break the bone.
3. Apply ice wrapped in a cloth for 15 to 20 minutes every 2 to 3 hours for the first 48 hours.
4. Take pain relief such as acetaminophen (paracetamol) or ibuprofen. Follow the label dose. Avoid ibuprofen if you have kidney problems, stomach ulcers or take blood thinners.
5. Remove rings and watches from that hand in case it swells.
6. Get checked the same day if you have any red flags above, or if you cannot use the arm.

Common shoulder injuries and how to tell them apart

Swelling after a shoulder injury

Swelling is a normal part of healing, but where it appears can point to the cause:

• Swelling at the side of the shoulder is common with a fracture of the upper humerus, a large rotator cuff tear or bursa inflammation. Bruising from a humerus fracture often tracks down the arm to the elbow and onto the chest over 3 to 7 days. This looks alarming but is expected.
• Swelling on top of the shoulder suggests an AC joint injury or a fracture at the outer end of the collarbone.
• Swelling along the collarbone points to a clavicle fracture.
• A swollen, hot, red shoulder with fever days after an injury or injection may be infection and needs urgent care.

Swelling should peak in the first 2 to 3 days and then settle. Increasing swelling, tight shiny skin, or swelling of the whole arm with numbness needs urgent review. See shoulder swelling for non-injury causes.

How a shoulder injury is diagnosed

A clinician will ask how you fell or what movement caused it, and whether the shoulder has ever dislocated before. They will look for deformity, check pulses, sensation and strength in the arm, and test movement and specific tendons.

• X-rays are the first test after a fall or blow. They show fractures, dislocations and AC joint separations.
• Ultrasound shows rotator cuff tears and bursitis, and can be done in clinic.
• MRI shows the rotator cuff, labrum, cartilage and hidden bone bruises. An MR arthrogram, with dye in the joint, is best for labral tears.
• CT scans plan surgery for complex fractures.
• Nerve studies if weakness or numbness persists.

Treatment

Most soft-tissue injuries

• Relative rest in a sling for comfort for a few days, not weeks. Prolonged immobilization risks a stiff shoulder.
• Ice early, then heat after 48 to 72 hours if it feels better.
• Pain relief with acetaminophen (paracetamol) or anti-inflammatory medicines, following the label dose.
• Gentle pendulum swings and range-of-motion exercises as soon as pain allows.
• Physical therapy to restore movement and then strength, especially of the rotator cuff and shoulder blade muscles.

Dislocations

The shoulder is put back in place (reduced) in the ER, usually with pain relief or sedation, then checked with an X-ray. A sling is worn for a short time before rehabilitation. Young athletes have a high chance of repeat dislocation, so surgery to repair the labrum is often discussed after the first episode.

Fractures

Most collarbone and many upper arm fractures heal in a sling over 6 to 12 weeks. Displaced, shortened or complex fractures may need plates, screws or, in older adults, shoulder replacement.

Tendon and labrum tears

Partial rotator cuff tears and many tears in older adults are treated with physical therapy and sometimes a steroid injection. Acute, full-thickness tears from an injury in active people are usually repaired surgically within a few weeks, because tendons retract and the muscle weakens if left. Unstable labral tears may need arthroscopic repair.

Recovery time

Older adults, smokers and people with diabetes heal more slowly. A common complication of any shoulder injury is stiffness or frozen shoulder, which is why early guided movement matters.

Preventing shoulder injuries

• Strengthen the rotator cuff and shoulder blade muscles, especially in throwing and overhead sports.
• Warm up and build training load gradually.
• Use correct technique for lifting, keeping loads close to your body.
• For older adults, fall prevention (balance training, good lighting, removing trip hazards) prevents most shoulder fractures.

Frequently asked questions

How do I know if my shoulder injury is serious?

Get urgent care if the shoulder looks deformed, you cannot move or lift the arm, there is numbness or a cold hand, the pain is severe, or the injury came from a high-energy accident. Pain that is not improving after 2 weeks also needs a medical check.

Why is there swelling at the side of my shoulder after an injury?

Swelling on the outer side often comes from a fracture of the top of the upper arm bone, a rotator cuff tear or an inflamed bursa. Bruising can spread down the arm over several days. An X-ray is needed after a fall, especially in people over 50.

How long does a shoulder injury take to heal?

Minor strains settle in 1 to 3 weeks. Dislocations and fractures usually take 6 to 12 weeks, and rotator cuff repairs 4 to 6 months or more. Physical therapy shortens recovery and reduces stiffness.

Should I keep my injured shoulder in a sling?

Use a sling for comfort for a few days unless a doctor has advised longer for a fracture or after surgery. Keeping the shoulder still for too long leads to stiffness. Start gentle movements as soon as pain allows and your clinician agrees.

Can a shoulder injury cause numbness in the hand?

Yes. A dislocation, fracture or stretch injury to the neck can damage the axillary nerve or brachial plexus, causing numbness, tingling or weakness. Any numbness after a shoulder injury should be checked the same day.