Shoulder Joint Bruises: Types, Causes, Treatment, Symptoms, Prevention

A Shoulder Joint Bruise or a bruised shoulder is a condition where the shoulder bone or the shoulder joint is hurt or injured resulting in development of purplish-bluish discoloration beneath the skin of the shoulder joint. Shoulder Joint Bruises are a common complaint among athletes and people who are involved in heavy physical activities, such as lifting weight or lifting heavy boxes etc. subcutaneous shoulder bruises usually do not require treatment and heal on their own. It can take up to four to six weeks for healing of shoulder joint bruises which are periosteal in nature.

Subcutaneous shoulder bruises are the least painful and heal rapidly without any treatment. Shoulder joint bruises which are subcutaneous are superficial bruises and are also known as contusions. These develop when there is breakage of the blood vessels, which are present under the skin of the shoulder resulting in collection of blood under the surface of the skin. Initially the shoulder joint bruise is purple or bluish-brownish in color, and then it can turn into green or yellow color as it heals. Shoulder bruises of this type usually heal on their own without requiring any treatment. Direct pressure to the affected shoulder joint produces pain and should be avoided.

Intramuscular shoulder bruises or shoulder muscle bruises can be painful and take longer time for healing than subcutaneous bruises. Intramuscular shoulder bruises are formed when there is breakage of the blood vessels and the blood collects in the shoulder muscle under the skin. Intramuscular shoulder bruises occur as a result of sharp jerk, blunt force trauma or torn muscle. The color of these types of bruises is usually blue or bright purple. Intramuscular shoulder bruises are also larger than subcutaneous shoulder bruises. In some cases, there is formation of hematomas near or over the shoulder joint injury. If the patient is having severe pain with shoulder joint bruise, medical attention should be sought to rule out a more serious injury to the shoulder joint.

Bone or periosteal shoulder bruises are usually the most painful and the healing time required for this type of shoulder joint bruise is also very long. Periosteal and intramuscular shoulder bruises respond well to rest, compression, ice, elevation and NSAIDs or non-steroidal anti-inflammatory drugs. Bone bruises or periosteal bruises develop when there is damage or injury to the blood vessels present in the cortex of the shoulder bone/joint. This is the external layer of the shoulder bone. If the cortex sustains extensive damage, then fracture of the shoulder bone can also occur along with bruising. Symptoms of periosteal shoulder bruise include acute pain, intense swelling and extensive discoloration. The discoloration and swelling subside gradually over a period of few weeks. Even though there is decrease in the pain, it can persist for over two to three months.

The pain, discoloration and swelling which are present with a periosteal bruise are usually so severe that a fracture is suspected and it needs medical attention. Some of the tests done to diagnose this include computed tomography (CT) scan, magnetic resonance imaging (MRI) exam. A simple x-ray is not helpful in detecting a periosteal bruise; however, it is useful in detecting a fracture. If there is no fracture, then the diagnosis of periosteal bruise is made by excluding the fracture according to which an appropriate course of treatment is planned.

Some of the common causes of shoulder joint bruises are injury or trauma to the shoulder joint, torn shoulder muscle, sharp jerk or pull to the shoulder. Falling and landing on the shoulder joint can cause fracture and bruising. Heavy lifting can also cause shoulder joint bruises.

• The shoulder bruise appears as a discoloration, which is bluish-purplish in color and can later turn to green-yellow in color during the healing stage.
• There is pain and swelling over the shoulder joint.
• Patient with shoulder joint bruise experiences pain and limited range of motion of the shoulder joint.
• There may be weakness of the muscles present around the shoulder joint.
• There can also be formation of hematoma at the site of the injury.
• If the injury which has caused the shoulder joint bruise is severe, then patient can also experience pinched nerves, tingling in the fingers and cold hands.
• Immediate medical attention should be sought if the amount of bruising is very large or if there is rapid swelling.

Investigations such as CT scan and MRI scan helps in diagnosis and extent of the shoulder joint bruise. X-ray helps in detecting if there is a fracture accompanying the shoulder joint bruise.

It is important to start treatment for shoulder joint bruises, which are intramuscular or periosteal in nature. Timely treatment helps in speeding up the healing process, preventing complications and alleviating pain. A shoulder joint bruise can be painful; however, it does not always necessitate medical attention unless it is very severe. The following conservative methods can be done at home to relieve the pain and discomfort from shoulder joint bruise:

Pressure: Applying mild pressure immediately after the injury helps in slowing or stopping the bleeding thus preventing the formation of bruise or hematoma.

Rest: Rest and immobilization of the shoulder joint is important to allow the shoulder joint bruise to heal. A shoulder sling can be used to achieve this purpose, i.e. to provide rest along with helping in preventing further injuries. A splint can also be used for immobilization, but make sure that it is kept dry all the times.

Cold Application: Ice application can be done to the front and back of the shoulder joint for about 20 minutes every two hours. This helps in relieving pain and swelling associated with shoulder joint bruise. The ice should be wrapped in a plastic bag or a towel before application. Ice should never be applied directly to the skin.

Compression: A compression wrap can also be used to help control the swelling in the shoulder. However, it is important to not wrap the shoulder very tightly, as there is danger of blood circulation being cut off.

Elevation: The injured shoulder should be kept elevated above the level of the heart even when sleeping.

Medicines: NSAIDs, such as naproxen and ibuprofen help in relieving pain and swelling associated with shoulder joint bruise. It is important to consult your doctor before starting them. Over-the counter pain relievers, such as Tylenol and Advil can also be taken. If the patient is prone to suffer from an upset stomach, then it is important to take the pain medications with milk or food.

Drainage: Drainage is needed if there is formation of hematoma on the shoulder and it does not heal. This hematoma can be related to a periosteal bruise or an intramuscular bruise.

Massage: Massaging the area, which surrounds the shoulder bruise, helps in increasing the blood flow and alleviating the swelling.

Exercises: Physical therapy including stretching exercises can be started the healing of the shoulder joint bruises. Exercises help in preventing stiffness; however, they should always be done under proper medical supervision. Uninjured areas of the shoulder or arm should also be exercised in order to maintain healthy muscle tone. Range of motion exercises help in speeding up the recovery process. They can be done by lifting the arm above the head and circling it from the shoulder. Gentle stretching help in keeping the muscles limber. Completely abstaining from physical activities during recovery time causes stiffness and a prolonged healing time.

It is important to follow a proper warm-up regime before and after exercising or doing any rigorous physical activity. Athletes or sports people should use proper shoulder padding or protection when playing to avoid injury and shoulder joint bruises. Applying mild pressure immediately after the injury to the shoulder joint helps in slowing or stopping the bleeding which in turn prevents the formation of bruise or hematoma.