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What Are the Most Common Shoulder Soft Tissue Injuries: A Quick Guide

December 12, 2023

Whether bowling, rowing a canoe, lifting boxes, or pushing furniture, we rely heavily on our shoulders for several daily activities. Normally, the shoulder can move a lot, giving it the ability to be the most flexible joint in your body. However, because of this flexibility, it is not very stable and is prone to injuries.

Soft tissue refers to ligaments, muscles, and tendons surrounding and supporting our joints. A soft tissue injury affects the tendons, muscles, and ligaments. Soft tissue injuries to the shoulder can occur as a result of a fall on an outstretched hand, overuse, or direct trauma. Before we answer the most commonly asked question, “What are the most common shoulder soft tissue injuries?” let us first talk about the anatomy of the shoulder.

The Anatomy of the Shoulder

The shoulder is a ball-and-socket joint. The upper arm bone, is capped with a ball-like structure that fits the shoulder anatomy into a shallow, cup-shaped socket in the shoulder blade (scapula). The labrum, a strong cartilage ring that lines the socket, gives the ball of the humerus extra depth in which to nestle.

One of the most common questions we get asked is, "What are the most common shoulder soft tissue injuries?"

The joint capsule is a type of protective sleeve of tissue surrounding the joint and comprises part of the ligaments that link the bones and the tendons that comprise the rotator cuff.

Most sports injuries involving the shoulder damage the connective tissues: the labrum, ligaments, and tendons. Issues with these shoulder components are far more common than broken bones and bruised muscles due to the high-force, high-repetition activities required by athletics.

What Are the Most Common Shoulder Soft Tissue Injuries?

Rotator Cuff Tear

The rotator cuff is a set of four upper arm muscles. They let you raise and rotate your arm. Tendons connect the muscles to the bones. If the tendons rip, the humerus cannot move as freely in the socket, making it difficult to raise or lower the arm.

As we age and become less active, tendons degenerate and lose vigor. This can cause rotator cuff tears.

Rotator cuff tears are mostly seen among the middle-aged and elderly with pre-existing shoulder problems. As for younger people, overhead arm use, repetitive movements, and stress to the tendons can lead to rotator cuff injuries.

Shoulder Sprain

Shoulder sprain refers to a separated shoulder or acromioclavicular joint injury.

The A.C. joint is where the acromion (the bony projection at the top of your shoulder blade)meets the clavicle or collarbone. In shoulder sprain injuries, ligaments that support and stabilize the shoulders are stretched, the shoulder is stretched or torn, and the bones of the A.C. joint become dislocated or separated.

Trauma to the shoulder is the primary cause of shoulder sprain injuries, E.g., a car accident and falling onto an outstretched arm.

Shoulder Strain

There are several types of shoulder injuries.

A shoulder tear occurs because of the injury to the soft tissues that provide the joint range of motion and stability. Tears can occur in the tendons, muscles, or labrums. A tear can be either partial or full, where it can cut through the tendon, muscle, or labrum completely. If small tears are ignored, they can worsen and become bigger over time.

Years of repetitive arm motions during sports, chores, or jobs can pave the way for a tear. A shoulder strain can occur in athletes who participate in repetitive activities, such as baseball, tennis, and weightlifting.

Shoulder Instability

Shoulder instability is seen predominantly in young people and athletes. It becomes unstable when the ligaments and muscles that hold the shoulder together are stretched beyond their usual limitations.

This health issue can be a normal part of youngsters' growth and development. Shoulders often stiffen and tighten with age.

In sporty people, shoulder instability is triggered by certain tackling, pitching, and bowling motions. These movements strain the shoulder greatly, stretching the ligaments over time. Pain can be either quick or gradual, or it can be the feeling that the shoulder is loose and a feeling of weakness in the shoulder.

Treatments include rest, physical therapy, or surgery.

Frozen Shoulder

Frozen shoulder refers to extreme stiffness in the shoulder. It is generally seen between 40 and 60 years of age. People with thyroid disease, diabetes, heart disease, or Parkinson's disease have a greater chance of getting affected by this.

The predominant symptom is not being able to move your shoulder in any direction without pain.

Overuse/Strains

A sudden increase in activity can put great pressure on shoulders and lead to loss of flexibility. It is generally among the middle-aged population who are not physically active and don't exercise regularly but go out suddenly for a physically demanding sport or work. Sportspeople should properly warm up before going to the field to avoid this type of injury.

Arthritis

Arthritis can also lead to soft tissue injury to the shoulder. As the smooth surfaces of the cartilage that lines the bones of the shoulder joint wear away, joints begin to wear out.

Treatment for arthritis-related shoulder injury depends on the severity of the pain. Usual treatments are rest non-steroidal anti-inflammatories (NSAIDs).

Shoulder Dislocation

A shoulder dislocation is a kind of shoulder injury.

A dislocated shoulder happens when the humerus gets dislodged from the glenoid, causing muscles and tendons to pull out of place and tear. Bone spurs, bony growths in the joint, can grind against tendons, creating friction and possibly a rupture.

Prominent symptoms are pain, decreased range of motion, and instability, which can feel like the shoulder may shift out of place.

Labral Tear

The labrum is a fibrous tissue rim surrounding the glenoid (shoulder socket).

A labral tear is a tear found in the labrum. The humerus head is wider than the socket, and the labrum deepens the socket, improving fit and stabilizing the joint. Several ligaments connect this portion of the shoulder. Injuries here might occur due to a single incident or from repetitive use of the shoulder.

A SLAP (known as superior labrum anterior and posterior) tear occurs when a labral tear affects the top part of the socket, where the biceps tendon joins to the shoulder.

Labral tear symptoms include slight clicking or popping noises when you move your arm, catching a sensation in the joint like it can't move any farther. This happens when a piece of labrum gets stuck between the joint bones.

How Long Does It Take For A Soft Tissue Shoulder Injury To Heal?

Many people are astonished at how long it takes to repair a soft tissue injury (muscle, tendon, or ligament) and question why they aren't totally recovered and back to normal within two or three weeks.

Unfortunately, this is normal because your body takes much longer to complete tissue recovery.

There are four main stages that your body goes through, although in reality, these aren't distinct, and they all overlap:

Phase 1: Bleeding

Just like a cut to your skin causes external bleeding, a bruise is a sign of bleeding from your internal soft tissues. Muscles have a very good blood supply and hence bleed more and for longer, resulting in a huge bruise. Ligaments have a limited blood supply. Therefore, they bleed less.

Resting during this phase is important to allow the bleeding to stop (approx. 4-6 hours).

Phase 2: Inflammation (Swelling)

Inflammation begins within the first hour or two after injury and peaks within 1-3 days but lasts at least a few weeks. In this phase, you will experience swelling and heat around the injury.

This is completely normal and part of your body's tissue-mending process. It has to happen, and there is nothing you can (or should) do to stop it.

  • Protect – don't try to push through pain and swelling. You can continue with activities as pain allows, but rest when you are able, especially in the first few days, to allow healing.
  • Optimal Loading – keep the injured area moving within a proper range to maintain strength and flexibility and trigger the next healing phase.
  • Ice – this will largely help with pain relief very early on. Applying an ice pack for roughly 15 minutes, 2-3 times daily, is a great idea.
  • Compression – you can apply gentle compression around your icepack using a towel. Compression bandages, like tubigrip, can be used at other times.
  • Elevation – keep your injured area supported and lifted while resting, especially when using an icepack.

Phase 3: Proliferation

To repair your injury, your body must produce scar tissue. This process begins within 24-48 hours and can extend for several months, usually ending within 4-6 months. So, if you're wondering why you still have some symptoms a couple of weeks after spraining your ankle or knee, it's because your body is busily laying down scar tissue.

The key to helping your body recover during this phase is to gradually exercise in a pain-free way that doesn't overload the brand-new scar but creates a bit of tension within it to build strength and flexibility.

Phase 4: Remodelling Phase

Even when you are past the stages of pain and inflammation, your injury isn't fully recovered. Ligaments, muscles, and tendons have different jobs in your body, and your new scar must be taught to behave like the structure it was formed to repair. Around 2-3 weeks, your body remodels the new scar to be as near the original tissue as feasible. This process can last up to two years.

Your risk of reinjury is higher during this phase due to loss of strength, flexibility, balance, and reaction time, so it's really important to follow a proper rehab program. Your program should also consider any underlying causative factors to prevent recurrence.

How Do You Exercise A Soft Tissue Damaged Shoulder?

You can still exercise an injured shoulder.

Finger And Wrist Flexion And Extension

Open and close your hand 10-15 times as stated. Then, 10-15 times, move your wrist up and down. Hold a softball/ball of socks after a few days. Squeeze the ball as hard as you can without hurting yourself.

Hold for 5 seconds before repeating ten times.

Elbow Bend to Straighten

Bend and straighten your elbow for a mild to moderate stretch. If necessary, use your other arm to assist. Do not force yourself into discomfort.

Forearm Rotations

Raise your elbow to your side. Make a 90-degree bend in it. Slowly spin your palm up and down until a mild to moderate strain is felt. If necessary, use your other arm to assist. Do not force yourself into discomfort.

If symptoms do not worsen, repeat 10-15 times more.

Postural Awareness

Squeeze the shoulder blades together and bring your shoulders back. You can do this with or without your sling. Hold the position for 20-30 seconds and repeat five times if symptoms do not worsen.

Soft tissue shoulder injuries shouldn’t keep you from functioning normally for too long. Learn more about how experts can help you recuperate and recover from soft tissue shoulder injuries!

© 2024, John Hibbitts, M.D. All Rights Reserved.