Shoulder Pain can be caused by a wide range of injuries or conditions. The shoulder joint itself is an extremely mobile joint with very low stability, leaving it open to injuries such as dislocations. The shoulder girdle (the joint itself, plus the AC joint, Scapula and surrounding muscles/ligaments/tendons) is also heavily involved in upper back and neck posture and so postural problems and muscle imbalances are also common shoulder issues. In general, shoulder injuries can be divided into two categories:
  1. Acute (traumatic) injuries
  2. Overuse/postural injuries
Acute Injuries Acute injuries are those that occur as a result of a sudden force or movement at the joint. The individual will usually know exactly when the injury happened and can often describe the event. They often describe a sudden pain and sometimes a clicking or popping sensation. Acute injuries may include:
  • Shoulder dislocations
  • AC joint injuries
  • Rotator cuff tears
  • Glenoid labrum injuries
  • Clavicle fractures
Treatment of an acute injury should involve immediate rest and the application of cold therapy, in the form of an ice pack or wrap. Taking the weight of the arm off the shoulder using a sling may also be recommended. Medical attention should then be sought to determine the nature of the injury and the appropriate course of treatment.
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  Overuse Injuries Overuse injuries are those where shoulder pain develops over a period of time, gradually becoming worse until the individual seeks medical attention. They usually cannot pin-point a specific incident which caused the pain and quite often the pain is not easy to pin-point, with no specific tender area. Overuse injuries are usually related to either poor posture or poor sporting technique (or any other activity), or both! Common overuse injuries include:
  • Impingement syndromes
  • Rotator cuff tendinopathy
  • Bursitis
Treatment of an overuse injury is often more difficult than an acute injury. Initially the aggravating activity should be ceased to allow the tissues involve to rest. Soft tissue treatments and electrotherapy may also be used to reduce pain and inflammation, as well as breaking down scar tissue and increasing muscle flexibility. Once pain and inflammation have subsided, an exercise rehabilitation program is usually implemented to address any postural problems and muscle imbalances which may have contributed to the injury. Other factors such as poor technique, training errors and unsuitable equipment should also be corrected.
Author: Heidi Mills BSc (Hons) is a Graduate Sports Rehabilitator who runs a clinic in Norwich (UK). She also works for the Virtual Sports Injury Clinic -
Note from Bruce: I have used Heidi several times as a sports medicine resource. She is the author of some of the sports injury resource library on the website. For more information about shoulder injuries check out our shoulder injury resource library. If you need help selecting a shoulder brace here is a blog I wrote previously.

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