Guide to Understanding and Managing Shoulder Injuries

Dr Bryan Tan, orthopaedic surgeon in Singapore.

Dr. Bryan Tan

Orthopaedic surgeon, MBBS (Singapore), MMed (Ortho), FRCS Ed(Orth)

Are you experiencing shoulder pain from a sports injury? Or perhaps you’ve strained yourself while performing household tasks. Regardless of how you’ve hurt yourself, shoulder injuries are a common occurrence that can significantly impact our daily lives, ranging from mild discomfort to severe limitations in movement and functionality. Whether you’re an athlete pushing your physical limits or just any other person engaging in daily living activities, understanding the spectrum of shoulder injuries can aid in prevention, early detection, and effective treatment. 

To help you understand better, Dr. Bryan Tan, an orthopaedic surgeon in Singapore, has put together this guide to shed light on the common causes of shoulder injuries and touch on useful management techniques and treatments. Keep reading for valuable insights and discover actionable steps aimed at empowering you to make informed decisions about your shoulder well-being.

Common causes of shoulder pain

From athletes to office workers, shoulder pain can arise from a variety of causes, leading to pain and restrictions in daily activities. Here, we look at some of the common ones to help you identify symptoms early, and set on a path towards recovery and prevention. 

SLAP tears

One of the culprits behind shoulder pain is SLAP tears. Short for Superior Labrum Anterior and Posterior tears, SLAP labral shoulder tears are injuries to the labrum of the shoulder joint. The labrum is a cartilage ring that surrounds the socket of the shoulder joint, providing stability and support. Typically associated with repetitive overhead arm movements seen in sports like baseball, tennis, or weightlifting, SLAP tears result from the ongoing stress placed on the shoulder joint. Symptoms often include deep aching pain in the shoulder, weakness, and a noticeable popping or clicking sensation during specific movements. 

Frozen shoulder 

Frozen shoulder is a term commonly used, but what is frozen shoulder, and how does it manifest? Also known medically as Adhesive Capsulitis, frozen shoulder is a debilitating condition marked by stiffness, pain, and a frustratingly limited range of motion in the shoulder joint. It often develops following periods of shoulder immobility, such as post-surgery or prolonged arm immobilisation in a sling. However, it can also be linked to risk factors like diabetes, thyroid disorders, and certain autoimmune conditions. 

Shoulder pain and stiffness that gradually worsen over time are the usual initial symptoms of a frozen shoulder. Suddenly, things that used to be as simple as reaching above your head, behind your back, or across your body become surprisingly difficult. To pinpoint this troublesome condition, doctors rely on a mix of clinical evaluation, range of motion tests, and sometimes imaging studies like X-rays or MRI to rule out other possible causes.

Rotator cuff tear

The rotator cuff is a group of four muscles and their tendons that stabilise the shoulder joint and facilitate arm movements. However, this group is prone to injuries such as tears or inflammation, which can be due to various factors. Such injuries may stem from repetitive overhead motions common in professions like swimming or painting, sudden traumatic incidents such as falling onto an outstretched arm, or the natural wear and tear associated with ageing. 

Identifying a rotator cuff tear can be challenging, but there are distinct signs to look out for, such as shoulder pain that worsens at night, weakness in the arms and shoulders, trouble lifting or reaching upward, and a popping or crackling feeling during arm movements. Diagnosis usually includes a thorough physical examination, imaging techniques such as ultrasound or MRI scans, and occasionally diagnostic injections to precisely pinpoint the tear’s location and severity.

Shoulder dislocation

A shoulder dislocation is when the upper arm bone pops out of the shoulder socket. This injury often occurs due to a significant impact or force applied to the shoulder joint, such as during a fall, sports-related collision, or sudden twisting motion. Shoulder dislocations are common among athletes involved in contact sports like football, rugby, and wrestling. Signs may manifest as intense pain, swelling, deformity or visibly displaced shoulder joint, inability to move the arm, and numbness or tingling down the arm. 

For an accurate detection and successful treatment of a shoulder dislocation, prompt medical attention is essential when it happens. Healthcare providers may perform physical manoeuvres or imaging studies like X-rays to confirm the dislocation and assess for associated injuries such as fractures or soft tissue damage. 

Learn more: My shoulder has been hurting recently and I’m not sure why. Should I be concerned? – Dr Bryan Tan

Shoulder instability

Shoulder instability refers to a condition where the shoulder joint is prone to excessive movement or dislocation due to ligament laxity or structural abnormalities. It can be classified as traumatic instability resulting from a significant injury or atraumatic instability due to inherent joint laxity or repetitive strain. Those with shoulder instability may experience recurrent episodes of shoulder dislocation or subluxation, where the humerus partially comes out of the shoulder socket. This instability can lead to pain, a feeling of shoulder looseness or “giving way,” weakness, and difficulty performing overhead or rotational movements.

Osteoarthritis

Osteoarthritis (OA) is a degenerative joint condition that commonly affects weight-bearing joints like the knees and hips, but it can also occur in the shoulder joint. OA of the shoulder typically develops over time due to wear and tear of the cartilage that cushions the bones in the joint. Factors such as old age, previous shoulder injuries, and overuse can contribute to its development. 

Those grappling with shoulder osteoarthritis often experience discomforts ranging from pain and stiffness to swelling and a noticeable decrease in range of motion within the affected shoulder. This pain, especially pronounced during movement, can significantly hinder everyday activities such as reaching overhead, dressing, or lifting objects. 

Bursitis and tendonitis 

Bursitis and tendonitis are inflammatory conditions that affect the bursae, fluid-filled sacs, and tendons around the shoulder joint respectively. This inflammation can result from repetitive raised movements, traumatic injuries to the joint, or underlying conditions like arthritis that worsen joint inflammation. Common symptoms include persistent pain during movement, swelling around the affected area due to bursa inflammation, and tenderness that worsens with pressure or specific actions. Conversely, tendonitis specifically involves inflammation of the tendons, which are fibrous tissues connecting muscles to bones.

Nonsurgical and surgical treatment options for shoulder injuries

Shoulder injuries can significantly impact quality of life, causing pain, limited mobility, and discomfort. Fortunately, modern medicine offers a range of treatments, both nonsurgical and surgical, to help ease the pain and restore functionality to your shoulders. In this section, we will explore the various treatment options available for shoulder injuries, each offering unique benefits and considerations tailored to address your specific needs and conditions.

Physical therapy

Physical therapy plays a crucial role in the rehabilitation of shoulder injuries, employing targeted exercises such as gentle stretches to boost flexibility, specific exercises to strengthen weakened muscles, and techniques to enhance shoulder range of motion. This approach proves invaluable for conditions like rotator cuff tears and frozen shoulders

Shoulder specialists work closely with patients to develop personalised treatment plans, gradually increasing the intensity of exercises as the shoulder heals. Over time, these treatments not only reduce aches but also restore shoulder function, returning your freedom and the ability to carry out everyday tasks effortlessly, all without the need for surgery.

Medication

In addition to physical therapy, medications are often prescribed to manage pain and inflammation associated with shoulder injuries. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and analgesics like acetaminophen can provide relief, allowing you to perform activities with greater comfort. While medications may not address the underlying cause, they help to reduce swelling, alleviate pain, and improve overall mobility, complementing other treatment methods for a comprehensive approach to shoulder injury management.

Keyhole surgery 

When measures such as physical therapy and medication fail to provide adequate relief, surgical intervention may be necessary. Keyhole surgery, also known as arthroscopic surgery, has altered the treatment of various shoulder conditions. This minimally invasive procedure involves small incisions through which a tiny camera and specialised surgical instruments are inserted into the shoulder joint. With such technology, orthopaedic surgeons can visualise the internal structures in real-time on a monitor, allowing precise diagnosis and targeted treatment. 

Moreover, keyhole surgery offers several advantages over traditional open surgery. The smaller incisions result in less tissue damage, reduced postoperative pain, and faster recovery times. After arthroscopic procedures like rotator cuff repairs, SLAP tear repairs, and addressing shoulder instability, you can look forward to improved shoulder function and relief from pain. These ongoing advancements in arthroscopic techniques are continually enhancing surgical outcomes, making it a viable choice for both patients and surgeons alike. 

Injection therapy 

Injection therapy proves incredibly effective in the comprehensive management of shoulder injuries, providing targeted relief and fostering healing in affected areas. Under the guidance of specialists and customised to individual needs, this treatment option plays a crucial role in restoring shoulder function, alleviating discomfort, and enhancing the overall quality of life for patients dealing with shoulder injuries. 

Corticosteroid injections, with their anti-inflammatory properties, provide rapid pain relief and help manage conditions like bursitis by reducing inflammation within the shoulder joint. On the other hand, viscosupplementation, through the introduction of hyaluronic acid, enhances joint lubrication and is particularly beneficial if you’re dealing with shoulder osteoarthritis, improving mobility and reducing pain over time. 

Keep in mind that regular monitoring and follow-ups are also key to achieving optimal outcomes, on top of combining injection therapies with other treatment methods for care that prioritises your well-being and recovery journey.

Orthotic devices 

Are you seeking extra support for your day-to-day activities as you recover from a shoulder injury? Orthotic devices can be a game-changer when it comes to supporting your shoulders and soothing any aches and pains. These customised braces or supports are specifically designed to provide stability and reduce strain on the shoulder joint during daily activities or sports. Whether you’re recovering from an injury or managing a chronic condition like arthritis, orthotic devices offer that additional layer of support that can significantly improve your comfort and mobility. 

With the assistance of a shoulder specialist to ensure the proper alignment of your shoulder and minimise movements that can exacerbate pain, these devices allow you to move more freely and confidently throughout your day, helping you tackle your obligations with greater ease and comfort as you heal and regain strength.

Lifestyle modifications 

Implementing changes in your daily routine can go a long way toward managing and preventing shoulder problems, as well as improving your quality of life. Simple things like adjusting how you sit at work or taking breaks to stretch can minimise strain on your shoulders, reducing the likelihood of issues like rotator cuff strains or tendonitis. Maintaining a healthy weight through exercise and a balanced diet also improves your general health by relieving pressure on your shoulder joints, which is particularly beneficial if you have osteoarthritis. 

Don’t forget to include targeted shoulder exercises and practise safe lifting techniques to build strength, improve flexibility, and reduce injury risks during your daily activities or workout routine. Remember that shoulder care extends beyond exercise sessions; mindful movement throughout your day is key to long-term shoulder health and function too.

Preventative measures: Safeguarding your shoulder health

Our shoulders play an essential role in our lives, allowing us to perform a wide range of movements from lifting groceries to reaching for that top-shelf item. However, many of us neglect to care for our shoulder health until discomfort or pain arises. Read on to learn these preventative measures, such that you can maintain strong, flexible, and pain-free shoulders well into the future. After all, it’s the cumulative effect of everyday mindful choices that creates a healthier experience for your shoulders and body as a whole.

Maintaining good posture 

On top of strength training, maintaining flexibility in the shoulders is crucial for preventing injuries and maintaining optimal joint function. Tight muscles in the chest, shoulders, and upper back can contribute to shoulder pain and limited mobility. Incorporate stretches such as doorway stretches for the chest, shoulder stretches like the cross-body arm stretch or behind-the-back stretch, and upper back stretches such as cat-cow stretches or seated twists. Hold each stretch for 15-30 seconds and repeat multiple times throughout your stretching routine. Yoga and pilates can also be beneficial for improving overall flexibility and promoting relaxation, which can indirectly benefit shoulder health by reducing stress and tension in the body.

Rest and recovery

After engaging in strenuous activities or workouts that target your shoulders, giving your muscles ample time to rest and repair is essential for long-term health and performance. Adequate sleep plays a pivotal role in the recovery process. During sleep, the body undergoes essential repair processes, including muscle recovery and growth. Aim for seven to nine hours of quality sleep each night to support these physiological functions. This not only aids in muscle recovery but also promotes overall mental and physical wellness, helping you feel refreshed and ready to tackle the day ahead. 

Equally crucial is staying sufficiently hydrated throughout the day, as water supports muscle function, joint lubrication, and overall cellular processes. Furthermore, consuming a balanced diet that includes protein, healthy fats, vitamins, and minerals is essential for muscle repair and recovery, helping to bolster your shoulder health and achieve your overall fitness objectives.

Listen to your body

Ignoring warning signs from your body can lead to overexertion or exacerbate existing shoulder issues. If you find yourself experiencing persistent pain, limited range of motion, or unusual sensations in your shoulders, adjust your exercise intensity, technique, or daily activities as needed to avoid unnecessary strain on your shoulders. Incorporating rest days into your workout routine and practising self-care techniques such as massage or heat therapy can also support your body’s recovery and resilience. 

Questions you may have

Understanding common shoulder pain is vital for everyone, whether you’re an athlete, an office worker, or simply living an active lifestyle. Let’s delve into some frequently asked questions about shoulder injuries to uncover effective strategies for optimal shoulder care.

What are the most common causes of shoulder pain?

Shoulder pain can arise from various causes, ranging from overuse injuries to underlying medical conditions. Common causes include rotator cuff injuries, such as tears or strains, which can occur due to repetitive overhead motions or sudden impacts. Dislocations, fractures, arthritis, and frozen shoulder syndrome are also frequent sources of shoulder discomfort. Furthermore, conditions such as bursitis and tendonitis, characterised by inflammation in the bursae or tendons of the shoulder, can develop due to overuse, improper lifting techniques, or age-related changes in the joint. 

When should I seek medical attention for shoulder pain?

If you experience a sudden and intense onset of shoulder pain following a fall, accident, or vigorous physical activity, it’s important to seek immediate medical attention. This response helps rule out serious issues such as fractures, dislocations, or acute injuries that require prompt medical intervention. 

Persistent shoulder pain that limits your range of motion, disrupts your daily activities, or worsens over time should also prompt a visit to a specialist. Keep an eye out for additional red flags such as swelling, warmth, redness, numbness or tingling sensations in the shoulder or arm, and difficulty bearing weight or lifting objects. With early intervention, you can prevent further damage, expedite recovery, and improve long-term outcomes for shoulder injuries.

Are there any ergonomic adjustments I can make to reduce shoulder strain at work?

Yes, making ergonomic adjustments in your workplace can significantly reduce shoulder strain and prevent repetitive stress injuries. Start by ensuring your workstation setup promotes proper posture and minimises awkward reaching or lifting motions. Adjust your chair height, desk height, and computer monitor position to maintain a neutral spine and relaxed shoulders while working. Use ergonomic accessories such as a supportive chair with adjustable armrests, a keyboard tray at elbow height, and a mousepad with wrist support to reduce strain on your shoulders, arms, and wrists. 

Can poor sleeping posture contribute to shoulder pain, and how can I improve my sleep ergonomics?

Poor sleeping posture can indeed contribute to shoulder pain and discomfort, especially if you tend to sleep on the same side consistently or with your arms positioned awkwardly. To mitigate this, you can use supportive pillows to ensure proper spinal alignment, avoid sleeping on the affected shoulder, and consider adjustable mattresses or pillows to support various sleeping positions more comfortably.

Conclusion

In conclusion, understanding and managing shoulder injuries is essential for maintaining overall shoulder health and functionality. Remember, attaining shoulder wellness for each person may vary, but with dedication, informed decisions, and the right support from healthcare professionals, achieving optimal shoulder well-being is within reach.

Ready to take control of your shoulder health? Don’t let shoulder pain or limitations hold you back any longer. Contact Dr. Bryan Tan today for personalised guidance from a shoulder specialist, and begin your journey towards a healthier, pain-free shoulder. 

The first step towards shoulder injury prevention is to simply get started.

Now that you’re aware of the different strategies which can help lower your risk of injury, you should make improving your overall shoulder health a priority. Even small habits such as practising good posture or stretching daily can go a long way.

Dr. Bryan Tan Photo

Dr. Bryan Tan

Orthopaedic Surgeon

Sports have always played a big part in Dr Bryan’s life. His interest in sports and varied sporting activities give him a deep understanding of sports injuries and the mindset of an athlete.

Dr Bryan Tan is a fellowship-trained orthopaedic surgeon, based in Singapore. He completed 2 fellowships in Orthopaedic Sports, Shoulder and Elbow Surgery in Sydney, Australia and Nice, France. Prior to private practice, Dr Bryan was a consultant in the Division of Shoulder and Elbow Surgery in National University Hospital (NUH), Singapore. He is currently still a visiting consultant at NUH where he actively teaches medical students and young orthopaedic surgical trainees. In addition, he travels to regional countries to teach advanced arthroscopic surgical techniques.

  • MBBS(Singapore)
  • MMed (Ortho)
  • FRCS Ed(Orth)


Dr. Bryan has a special interest in keyhole surgery and performs most of his surgeries using advanced, modern keyhole surgical techniques. He regularly visits fellow surgeons from other countries to ensure his skills and knowledge are cutting edge.

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