Diagnosing Shoulder Sprains & Strains

Doctors at NYU Langone Orthopedic Center are experts in diagnosing shoulder sprains and strains.

The shoulder is a flexible ball-and-socket joint that consists of several interconnected parts. The glenohumeral joint connects the shoulder socket, or glenoid, to the arm bone, or humerus. The acromioclavicular joint connects the acromion, the boney projection at the top of the shoulder blade, to the collarbone, or clavicle. A shoulder injury can occur when stress is placed on the tissues that stabilize the joints. These include the muscles; the tendons, which anchor muscle to bone; and the ligaments, which are tough cords of tissue that connect and support bones.

Shoulder Sprain

A shoulder sprain, also known as separated shoulder, occurs when the ligaments that support and stabilize the shoulder are stretched or torn, and the bones of the acromioclavicular joint become dislocated or separated. Direct trauma to the joint—for example, from a car accident or fall onto an outstretched arm—is common cause of a shoulder sprain.

Shoulder sprains increase with severity based on the extent of damage to the ligaments and by how much the clavicle has separated from the acromion.

With mild sprains, acromioclavicular joint ligaments stretch or partially tear, but the bones don’t separate. Pain and swelling may interfere with normal daily activities, such as putting on a coat or reaching across your body.

With more severe strains, the acromioclavicular joint completely separates. Tears in the acromioclavicular ligament and other the nearby ligaments that connect the shoulder blade to the clavicle can dislocate the collarbone, causing a bump on the shoulder. Muscles can also detach from the collarbone. Symptoms such as bruising, pain, and swelling can prevent you from performing your usual activities.

Shoulder Strain

A shoulder strain is a stretching or tearing of some fibers in a muscle or tendon in the shoulder. Playing sports that require repeated overhead movements of the arms, such as swimming or tennis, increases a person’s susceptibility to shoulder strain. Aging also increases the risk of developing tears of the muscle or tendon caused by normal repetitive motions.

Physical Exam and Medical History

Our doctors conduct a thorough physical exam to evaluate the shoulder’s range of motion and strength and assess your level of discomfort while you move. They need to know where you feel pain and whether it’s consistent or intermittent or gets worse during arm movement. Doctors may ask whether you experience any weakness or limited movement and may want to know if you have had a dislocated shoulder or shoulder surgery in the past.

You may be asked to recall any incident, such as a fall, that led to shoulder pain, weakness. Your daily activities may provide additional clues about the cause and nature of your injury. Jobs that require you to repeatedly lift your arms, such as house painting or hairstyling, may stress the soft tissues in the shoulder. If you’re an athlete, years of overhead motions may gradually wear down the soft tissues in the shoulder. At some point, a movement may cause them to become sprained or strained.

Imaging Tests

Doctors use X-rays of the shoulder to examine the bones and determine if any bone spurs are present or if there is a fracture, which can cause similar symptoms. X-rays can also help doctors rule out osteoarthritis of the shoulder as the cause of your symptoms.

An ultrasound can reveal tears in tendons or impingement, which is when a tendon gets caught under the shoulder blade during arm movement. Ultrasound may also help doctors determine if you need an MRI scan, which can provide a clearer view of the soft tissues to reveal subtle damage to muscles, tendons, and ligaments of the shoulder. An MRI scan can diagnose other conditions of the shoulder, including a torn rotator cuff or shoulder labral tear. It can also diagnose conditions of the upper arm, including a proximal biceps tendon rupture.