Shoulder Strain – Shoulder Muscle Pain
Shoulder strain results from muscle tears, as opposed to a sprain, which is a tear of a ligament. These tears can be significant is some cases, requiring surgery as in rotaor cuff tears. However, most instances of muscle tears will heal. The healing of strained muscles is done by forming scar tissue. Similar to a cut on the skin, there is bleeding, inflammation and pain. Healing progresses from the bleeding stopping, to a scab and then a scar. Optimal scar tissue formation has the scar fibers aligned with the muscle fibers. In this manner, shoulder muscle function is maximized.
What Happens With Poor Healing?
A shows health surrounding muscle tissue and scar tissue that has formed poorly. B shows health muscle tissue and a properly healed scar tissue.
Scar tissue is not as strong or flexible as healthy tissue. In areas of shoulder strain where there is poorly formed scar tissue, there is a weak area that is subject to re-injury and is more sensitive to pain as new nerve growth constantly tries to reconnect with the damaged area. This scar tissue can stick or adhere to muscles and nerves, which may pull and irritate the area during work, sports or everyday activities. This can lead to more pain, muscle spasm and restricted motion.
Where scar tissue is properly aligned with muscle fibers (B), the area of strain is strong and the muscles, tendons, nerves and circulation can function normally.
With chronic shoulder pain such as bursitis, tendinitis, arthritis and fibrositis, muscle balance must be regained to relieve pressure and irritation from these tissues.
How Do You Heal A Shoulder Strain?
Regaining proper function is essential to healing a shoulder strain. This is done by treating areas of shoulder strain or muscle damage through specific therapy techniques, restoring muscles to their normal length by stretching and using the exercises for shoulder pain, and preventing factors that can cause these problems to continue. The use of a shoulder pillow may be helpful
How Do I Strain My Shoulder?
Shoulder strain can result from a single injury or from repeated minor trauma that may not be noticed until it becomes problematic. This can be from repeated motions during work or from poor posture.
What Areas Are Involved?
A strain of the shoulder can involve one or more muscles. Certain muscles have areas which are prone to strain and chronic irritation. These areas, sometimes called trigger points, can cause local muscle pain and can even refer pain, similar to radiculopathy. We will review muscles commonly strained in the shoulder and some tips on how to help with self treatment, prevention, and recognition.
Common Muscles Involved
The black “X” indicates the area of the muscle with irritation, tear or trigger point and is the main location of pain or tenderness. The more solid areas of red are the primary area(s) where pain can be referred to, is usually felt and can be very painful when pressing the “X” area(s). The less solid red areas are area(s) of referred pain where pain is sometimes felt. A White “X” is an area of a tendon, the point where the muscle ends and attaches to the bone.
The first 4 muscles are muscles whose tendons attach to the shoulder forming what is called the rotator cuff. The muscles of the rotator cuff are the supraspinatus, infraspinatus, teres minor and subscapularis. These may be involved individually, or together. The first 3 are similar in location and function. The shoulder is surrounded by muscles of the rotator cuff. When these are affected the shoulder can become dysfunctional. The tendons, which attach muscles to bones can also become irritated due to a rotator cuff strain. Bursitis is a common source of inflammation. This can lead to chronic pain, irritation and dysfunction of the shoulder, making prone to arthritic conditions and further injuries.
The supraspinatus muscle is one of the rotator cuff muscles. When the supraspinatus muscle is involved in shoulder strain, it is usually felt as a deep ache that extends part of the way down the arm. There can be shoulder stiffness, difficulty reaching above the shoulder and sleep disturbance may be experienced, especially when other muscles are involved. There may be snapping or clicking sounds involved with this muscle.
Strain of this muscle may occur when heavy objects are carried with the arms hanging down like a heavy briefcase, lifting above the shoulder with arms out or walking a large dog that pulls on the leash.
When the major hand is involved, there may be difficulty with combing hair, brushing teeth or shaving. It may affects sports activities like a tennis serve.
There is restriction of motion when performing the hand to shoulder blade test. As indicated in the illustration, the fingertips of the hand should be able to reach the shoulder blade at the part where the broken blue line is. This corresponds to the location of a bony part of the scapula called the spine of the scapula. In this picture, there is restricted motion. This indicates a problem with the supraspinatus, and we will see this again with other muscles that are similarly located.
Avoid carrying heavy objects with the hand and arm hanging at the side, lifting overhead and motions like holding arms up for long periods like putting curlers in hair or hanging curtains. Stretching corresponds to shoulder pain exercises #3, and this can be done with moist heat in the shower.
The infraspinatus is another muscle of the rotator cuff and shoulder strain of this muscle causes typical shoulder joint pain as it is felt deeply, more so than the supraspinatus muscle above, and especially in front of the shoulder. Note the area of referred pain in the neck, which is sometimes experienced. Sleeping is difficult not only on the affected side, but the opposite side also, and sometimes even the back. There can be difficulty reaching to a back pocket, bra hooks, zipping up a dress, and in front to comb, brush teeth or placing the arm in a coat or shirt sleeve. Tennis players may complain about the strength of their serve.
Strain of this muscle may be caused by reaching out and back frequently, like a bedside stand, grabbing backward to brace yourself when slipping,too much polling during skiing, a hard tennis serve, especially when off balanced or missing the ball, or teaching someone to skate by dragging them by the arm for a long time. There is restriction doing the hand to shoulder blade test.
Avoid putting curlers in the hair, move a bedside table more in front, so you do not have to reach backward. Sleep supporting the arm and forearm using a pillow or use a body pillow to prevent overstretching the muscle and causing shoulder pain. Stretching is similar to the supraspinatus along with stretching. Stretching can also be performed pulling the painful arm across the front of the body with the good arm, again, under the moist heat of a shower is a good way to do this. Do the stretch in front first, then in the back.
Teres Minor Muscle
The teres minor muscle is also involved in the rotator cuff, below and smaller than the infraspinatus muscle. Shoulder strain of this muscle causes a sharp and deep pain in a small area, which is often mistaken for bursitis. It can cause some restriction performing the hand to shoulder blade test. It causes pain more than restricted motion. The pain of the teres minor can be overshadowed by the infraspinatus. When the infraspinatus problem is remedied, with its pain in the front of the shoulder, the teres minor is usually noted, with its pain at the back of the shoulder.
The causes and prevention strategies are similar to the infraspinatus. Avoid overloading or repetitive use, stretching and proper support when sleeping is beneficial.
This is the last of the rotator cuff muscles and perhaps the most complicated. Symptoms of a shoulder strain involving the subscapularis are often diagnosed as a frozen shoulder, with a progressive and painful restriction of the arm. With pain at the back of the shoulder on motion and at rest, there is sometimes a band of referred pain around the wrist, with the back of the wrist being more painful than the front, and this may cause an individual to move a wristwatch to the other arm. The location, being the underside of the scapula, makes this muscle difficult to reach. Deep pressure can be applied deep into the armpit area to reach parts of this muscle.
Early in the stage of this shoulder strain, reaching up and forwards is not restricted, however, there is pain and restricted motion reaching backward at shoulder level, like the start of throwing a ball. As the strain progresses, pain is present with motion as well as rest, with problems reaching across to the opposite shoulder. This is usually the point where one is diagnosed as having a frozen shoulder, adhesive capsulitis or a pitcher’s arm. This can also lead to instability of the shoulder joint.
Strain of the subscapularis is often caused by forceful motion like the overhead part of a swimming stroke or throwing a baseball, repeated overhead lifting with strong motion of the shoulder pulling into the body or reaching back to stop a fall. Strain of this muscle is also from a shoulder dislocation, arm fracture, tearing of the shoulder joint capsule and with long term immobilization with the arm held inward, like placing your hand on your stomach.
When sleeping on the back or the painful side of a subsacapularis shoulder strain, use a pillow in-between the elbow and side of the chest. When sleeping on the pain free side, use pillow support shown for the infraspinatus shoulder strain above. When standing for long periods, hook your thumb on your belt or have your hand on your hip in order to prevent the arm from staying close to the side. When sitting, move your arm frequently to stretch it and keep it mobile. When driving, if it is the right arm, rest the arm across the back of the passengers front seat.. If it is the left arm and you can have the window open, hold on to the roof of the vehicle with your left hand.
You can get a good stretch of this muscle by using the doorway stretch illustrated on the page for pain in between the shoulders. This can be done 3 times a day for 3 repetitions. Using a hot pack prior to stretching can increase the benefits. Similar to shoulder pain exercises #1, you can do this in a circular motion for the subscapularis shoulder strain, performing it clockwise for the left arm and counter-clockwise for the right.
Teres Major Muscle
The teres major muscle is not a part of the rotator cuff, although it is similar in location. A shoulder strain involving the teres major is felt deep in the back part of the shoulder. It can be aggravated when driving and would be a major complaint when driving older vehicles without power steering. Strain of this muscle may also cause pain when reaching overhead, noted with some tennis players when serving. There may be pain when resting, but this is usually mild in nature. Strain can be caused by reaching across the body at shoulder level. This would correspond to driving and exerting force when turning the wheel to the opposite side. It may arise if you have recently put on heavier tires, making it harder to turn the wheel.
Correct any driving difficulties as noted and refrain from lifting weights overhead. Stretching the muscle is done by placing the arm and hand behind the head, touching the opposite side of the neck. Again, under the moist heat of a shower is a good time to do this stretch. Sleeping support is done in the same manner as the infraspinatus
Shoulder strain of the deltoid muscle is common and pain is usually located to the side or back of the shoulder, with referred pain fairly localized to the upper arm. This muscle can be often injured in contact sports. There is pain on shoulder movements, mainly is raising the hand to the mouth when brushing teeth and reaching backward at shoulder level.
Shoulder strain of the deltoid in the front of the muscle is often caused by impact trauma like being hit with a ball or recoiling of a gun held against the shoulder. It can be injured when catching yourself falling forward. It can also be injured by repeated strain like when using a power tool at shoulder level or deep sea fishing and over polling when skiing. It can also be an area of soreness when receiving injections, a common location. Noting areas of trigger points can help with avoiding injections in those regions.
Pain from a deltoid shoulder strain can feel similar to rotator cuff tears, tendinitis and bursitis. The pain is also similar to that from a sprain or dislocation of the acromioclavicular joint.
You can try lifting using your thumb down to relieve the front part of the deltoid, or the thumb up for the back part of the deltoid. Be careful when using steps and holding onto a railing. Enthusiasts of shooting rifles should use padding in front of the shoulder to minimize recoil.
A coracobrachialis shoulder strain causes pain mainly in the front of the shoulder and in the back. There is pain when reaching to the back and this is called the back rub test. In this example, you can see where the arm should go, and how it is restricted by the coracobrachialis shoulder strain.
You should avoid lifting heavy objects using the arms out in front – keep the elbows close to the body. The door stretch using the hands in a low position will help in stretching this muscle.
Areas of shoulder strain the biceps are usually found in the lower part of the muscle, but often refer pain to the front of the shoulder. The pain may be mistaken for bicipital tendinitis or subdeltoid bursitis. The pain is in the front of the shoulder, but is not deep.
Lifting heavy objects with the hands pointed up is a common means to overload and strain the biceps muscle. Most are familiar with the actions of the biceps muscle and things like long hours of playing the guitar or violin, using a manual screwdriver, turning a stiff doorknob, shoveling snow or hard tennis serves as well as weight lifting can strain this muscle.
The muscle crosses 3 joints and can be complex to stretch. A doorway stretch with the thumb pointing down can help. Learning to lift with the hands pointed down can help. Sleeping support uses a pillow to prevent tight bending at the elbow.
Strain of this muscle is usually involved in mid back pain and even low back pain, but can refer pain to the front of the shoulder. The muscle covers a wide area from the back and goes into the shoulder. Shoulder pain may not be the main complaint, however, the muscle is difficult to stretch and the shoulder is involved. In mid or lower back pain, it is important to look into additional sources of strain. In this case, the shoulder is a good place to look, just like in neck problems, the shoulder can also be involved or be the main culprit.
Strain involving the latissimus dorsi muscle can result from repeated reaching forward and upward, like carrying a large unevenly weighted box or chair, pulling drapes daily. Sleeping support is the same for the biceps muscle in order to prevent shortening or spasms of the muscle when at rest. The doorway stretch is a good way to stretch the muscle.
The pain from a shoulder strain of the rhomboid muscles is often associated with mid back pain and is discussed in detail in the section on pain between the shoulders. It can cause a nagging pain in the mid back and is often involved with shoulder problems. It can be painful without motion and is felt more superficially. It can be strained by poor posture with rounded shoulders and leaning forward while sitting.
Other muscles are associated with shoulder pain, however, we have gone over the major ones. With neck and shoulder pain, it is important to look into neck strain, because some of the muscles of the neck will also attach to the shoulder, thus the relationship between neck and shoulder pain, similar to a relationship between mid or lower back and shoulder pain.
How To Treat A Shoulder Strain
Remember, shoulder pain should always be evaluated by a health care provider. Injuries can cause fractures, dislocations and shoulder strain as well as sprain can be severe enough to warrant surgery. There are also other conditions that can refer pain to the shoulder. For treatment, we shall consider basic muscular shoulder strain.
If recent, a shoulder strain may benefit from the use of ice therapy to minimize swelling. After a day or so, and with more long standing or chronic problems, moist heat should be applied.
The shoulder pain exercises is a program for regaining motion and function of the shoulder as well as reducing pain.
Specific therapy to the muscles can be done using pressure. You can use a tennis ball to the areas illustrated above, holding it with pressure against the area for about 20 to 30 seconds, until the pain subsides. This is sometimes called ischemic compression and it helps with circulation. Alternatively, there are more sophisticated tools that can be used to achieve better results and can treat very specific areas of shoulder strain using minimal force or strain.
Treating shoulder strain muscles can be complex. They can be difficult to locate and hard to reach. Many cases of self treatment with pressure therapy, exercises and heat will be successful, however, there are cases where professional help is needed. Many Chiropractors, Physical Therapists and Massage Therapists can help. With difficult cases, ones that involve long standing scar tissue, an expert may be needed.
I have not only been a patient needing a special type of muscle release treatment, but I have become proficient in the use of Active Release and have seen great results both as a patient and as a treating doctor. If you are having problems with self treatment and do not have a clear diagnosis, you can find and expert for treatment of scar tissue and muscle problems related to shoulder strain here.
Sometimes, shoulder surgery is necessary. Full thickness tears are not usually amenable to therapeutic measures and are susceptible to further injury. These are usually discovered after an initial x-ray to rule out pathology, and subsequent failure of conservative measures like physical therapy and/or injections.
A 2022 study in the Journal of Shoulder and Elbow Surgery showed older age, decreased active external rotation, and both subscapularis and supraspinatus/infraspinatus tears were risk factors for osteoarthritis.
I have had two shoulder surgeries on the same shoulder. The first one healed very well, however, the second one was horribly mismanaged by a very bad physical therapist, resulting in permanent tears, pain and dysfunction. A good, knowledgeable, experienced physical therapist is crucial to healing from surgery. Do your homework on this.