A bruised shoulder is a common complaint, particularly among athletes, given the amount of abuse that the shoulder endures. Subcutaneous shoulder bruises are the least painful, heal the most quickly and typically do not require treatment. Intramuscular bruises, or muscle bruises, tend to hurt more and take longer to heal than subcutaneous bruises. Finally, periosteal, or bone bruises, generally are the most painful and require the longest time to heal. Intramuscular and periosteal shoulder bruises respond well to rest, ice, compression, elevation and the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain control.
Subcutaneous shoulder bruises are superficial bruises, also known as contusions. They occur when the blood vessels immediately below the shoulder skin’s surface break and blood pools under the skin’s surface. Purple or brown in color at first, a subcutaneous shoulder bruise might turn yellow or green as it heals. Bruised shoulders of this nature generally heal on their own after a few days. Other than protecting the area from direct pressure to avoid pain, little else is required in the way of treatment.
Intramuscular bruises occur when blood from broken blood vessels in a shoulder muscle pools below the skin in response to blunt force trauma, a sharp jerk or an actual muscle tear. These types of bruises typically are bright purple or blue and generally are larger than subcutaneous bruises. Hematomas, which are blood-filled lumps, sometimes form over or near the shoulder injury. In instances of acute pain in a bruised shoulder muscle, medical attention is recommended to rule out a more serious shoulder injury.
Periosteal bruises, or bone bruises, occur when damage is sustained to the blood vessels in the shoulder bone’s cortex, the outer layer of the shoulder bone. If the damage to the cortex is extensive enough, the shoulder bone fractures, which also can result in bruising. Signs of a periosteal shoulder bruise include severe pain, marked swelling and extensive discoloration. The swelling and discoloration usually resolve on their own over the course of a few weeks, but although the pain might lessen, it can persist for up to two or three months.
The pain, swelling, and discoloration associated with a periosteal bruise typically are so intense that a fracture is suspected and medical attention is required. A magnetic resonance imaging (MRI) exam or computed tomography (CT) scan will detect a periosteal bruise. The less sophisticated — and less expensive — simple X-ray will not detect a periosteal bruise. An X-ray will, however, detect a fracture. If none is found, then the periosteal bruise is diagnosed by ruling out a fracture, and an appropriate course of treatment is determined.
Applying proper remedies for a bruised shoulder that has suffered an intramuscular or periosteal bruise is important to promote timely healing, prevent complications and manage pain. A shoulder sling can be used to immobilize the bruised shoulder to allow it to rest and to avoid further injury. Ice can be applied to the front and back of the shoulder for 15 minutes every hour to reduce swelling. A compression wrap also will help control swelling in the shoulder, but care should be taken not to wrap the shoulder so tightly that circulation is cut off. Finally, the injured shoulder should be elevated above the heart, including while the sufferer is sleeping.
NSAIDs can be used for pain relief according to the manufacturer’s directions. Examples of NSAIDs include aspirin, ibuprofen and naproxen. NSAIDs are not recommended for use by certain individuals, so a pharmacist or medical practitioner should be consulted before they are used. Additionally, if a hematoma forms on the shoulder and does not heal on its own, whether it is related to an intramuscular bruise or to a periosteal bruise, medical attention might be required to drain it. A more severely bruised shoulder, such as in the case of a periosteal bruise, might benefit from stretching exercises or even physical therapy after healing has begun, in order to prevent stiffness, but any physical therapy should be undertaken only under proper medical supervision.