Open Wound of the Shoulder

First aid for a shoulder wound

1. Protect yourself: wear gloves if available.
2. Stop the bleeding: press firmly on the wound with a clean cloth or dressing for at least 10 minutes without lifting to check. Add more layers if blood soaks through. For severe bleeding near the armpit, pack the wound with gauze and keep pressing hard, as tourniquets cannot be applied at the shoulder.
3. Clean the wound: once bleeding is controlled, rinse with clean running water for several minutes. Remove loose dirt. Do not dig for deeply embedded objects.
4. Do not use hydrogen peroxide or iodine directly in the wound, as they can damage tissue.
5. Cover with a clean, non-stick dressing.
6. Support the arm in a sling if movement is painful.
7. Seek care for any of the warning signs above.

Why shoulder wounds can be serious

The shoulder contains important structures close to the surface:

Types of shoulder wounds

• Abrasions: scrapes from falls or road rash, usually superficial but can contain embedded dirt
• Lacerations: cuts from sharp objects or blunt impact. See laceration
• Puncture wounds: from nails, knives or bites; small surface but possibly deep
• Bites: dog, cat and human bites carry high infection risk
• Avulsions: skin torn away in a flap
• Penetrating trauma: stab or gunshot wounds, which need emergency assessment

Medical assessment and treatment

A clinician will check the wound, nerve function, blood supply, shoulder movement and strength, and may order:

• X-rays for fractures or foreign bodies such as glass or metal
• Ultrasound for foreign bodies or tendon injuries
• CT angiography if a blood vessel injury is suspected

Wound closure

• Stitches, staples or skin glue for clean, gaping wounds, ideally within 6 to 8 hours. Clean shoulder wounds can sometimes be closed up to 12 to 24 hours later
• Delayed closure for contaminated wounds or bites, which may be left open initially and closed after a few days if clean
• Surgical repair for tendon, muscle, nerve or blood vessel injuries, or joint washout if the joint is involved

Stitches on the shoulder are usually removed after about 10 to 14 days, as the skin there is under tension.

Preventing infection

• Thorough cleaning (irrigation) and removal of dead tissue
• Antibiotics for bites, heavily contaminated wounds, joint involvement or people with diabetes or weakened immunity
• Tetanus vaccination: a booster if more than 10 years have passed, or more than 5 years for dirty or deep wounds. Tetanus immune globulin may be given to people with incomplete vaccination. See tetanus

Caring for the wound at home

• Keep the dressing clean and dry for the first 24 to 48 hours, then gently wash with soap and water
• Apply petroleum jelly and a fresh dressing daily
• Avoid lifting heavy objects or stretching the shoulder in ways that pull on stitches
• Take acetaminophen (paracetamol) or ibuprofen at the label dose for pain
• Watch for signs of wound infection

Complications

• Wound infection and cellulitis
• Septic arthritis if the joint was entered
• Wound reopening (dehiscence) due to shoulder movement
• Shoulder stiffness after prolonged immobilization
• Nerve damage with numbness or weakness
• Wide, stretched scars or keloids, which are common on the shoulder
• Chronic pain

Scar care

The shoulder is a common site for thick, raised or keloid scars. Once the wound has fully closed, silicone gel or sheets, sun protection and gentle massage may improve the scar. People prone to keloids should mention it to their clinician early.

Frequently asked questions

Does a cut on my shoulder need stitches?

It likely needs stitches if it gapes open, is deeper than about 6 mm (a quarter inch), shows fat or muscle, has jagged edges, or keeps bleeding after 10 minutes of pressure. Ideally, get it closed within 6 to 8 hours of the injury.

How do I clean a shoulder wound?

After stopping the bleeding with pressure, rinse the wound under clean running water for several minutes and gently remove loose debris. Avoid hydrogen peroxide and iodine inside the wound. Cover it with a clean, non-stick dressing.

What are the signs of an infected shoulder wound?

Signs of infection include increasing redness, warmth, swelling and pain, pus or cloudy discharge, a bad smell, red streaks spreading from the wound, and fever. See a doctor promptly if these develop.

When do I need a tetanus shot for a wound?

You need a booster if your last tetanus vaccine was more than 10 years ago, or more than 5 years ago for a dirty, deep or puncture wound. If you never completed the vaccine series, you may also need tetanus immune globulin.

How long does a shoulder wound take to heal?

A simple cut usually heals in 1 to 2 weeks, with stitches removed after about 10 to 14 days. Deeper wounds involving muscle, tendon or nerve take longer and may need physical therapy. The scar continues to mature for up to a year.