A shoulder contusion, or bruising of the shoulder muscle, is a mild sports injury that can occur due to a direct blow or a fall. The muscle may be stretched but doesn’t tear. You may have visible bruising just below the skin as well as deeper bruising.

While a shoulder contusion is uncomfortable and may temporarily make it difficult to move your arm normally, it’s an injury that typically resolves quickly.

Symptoms

Pain around the shoulder joint
Ecchymoses, or ‘black and blue’ bruising or redness
Swelling around the shoulder
Usually able to raise your arm, but with difficulty.

Causes

A shoulder contusion usually results from a fall or a direct blow to the shoulder.

Any blunt trauma with sufficient force to propel its energy into the muscle can cause a contusion. Contusions are often the result of sports-related injuries.

Anatomy

Skeletal muscles are made up of bundles of muscle fibres. The muscle is surrounded by a protective sheath called the Epimysium. Contusions are either intramuscular or intermuscular depending on whether the bleeding is contained within the muscle sheath, or whether the sheath is also damaged and the muscle bleeds outside the muscle sheath.

Intramuscular

Intramuscular hematoma is a tearing of the muscle within the sheath that surrounds it. This means that the initial bleeding may stop early within hours because of increased pressure within the muscle, however, the fluid is unable to escape as the muscle sheath prevents it. The result is considerable loss of function and pain, which can take days or weeks to recover. You are not likely to see any bruising come out with this type – especially in the early stages.

Intermuscular

Intermuscular hematoma is a tearing of the muscle and part of the sheath surrounding it. This means that the initial bleeding will take longer to stop, especially if you do not ice it. However, recovery is often faster than intramuscular as the blood and fluids can flow away from the site of injury. You are more likely to see bruising come out with this one. If after two to three days the swelling has not gone, then it is probably an intramuscular injury

Treatment

Rest, including taking a break from play and avoiding heavy lifting

Using a sling to rest your shoulder, if recommended by your therapist

Icing your shoulder (every one to two hours for 20 minutes) – The general recommendation is to avoid heat during the first 24-48 hours to avoid increasing the extent of bleeding and swelling.

Over-the-counter pain medication, like ibuprofen or acetaminophen, if needed.

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