Deltoid Strain

By Brian J. Ludwig, MD

Shoulder pain in an athlete is a very common malady. Pain in the shoulder can be debilitating for athletes of all ages and competition levels. One possible, but relatively uncommon cause of shoulder pain is called a deltoid strain.

 

What is the deltoid muscle and what does it do? 

deltoid strainThe deltoid muscle is a large muscle that encompasses the shoulder joint. The deltoid is divided into three different portions, or heads, the anterior (front), middle, and posterior (back) portions of the deltoid. The deltoid originates on the lateral aspect of the acromion and clavicle and then inserts on the lateral aspect of the humerus. Its major action is to abduct the arm (lift the arm out to the side of the body) as well as assist in forward elevation (lifting the arm out in front of the body). The deltoid is a very powerful muscle and is needed for all types of athletic endeavors. 

 

Difference between a strain and a sprain 

Strains are injuries to muscles or muscle tendon units. Sprains are injuries to ligaments. Because the deltoid is a muscle, it can be strained, but not sprained.

 

What other injuries can mimic a deltoid strain? 

There are many injuries in the shoulder that can mimic a deltoid strain. At times, these injuries can be difficult to distinguish one from the other. Some other things that can be injured include: the rotator cuff, glenoid labrum, biceps tendon, acromioclavicular joint (AC joint), shoulder dislocations, shoulder fractures, and soft tissue contusion. Many of these injuries can be treated conservatively, however some of these injuries require surgical intervention and need to be evaluated by a sports medicine physician to determine the extent of the injury.

 

Why does my Deltoid hurt? 

Deltoid strains can be caused by numerous mechanisms. Most commonly they result from overuse of the muscle without adequate rest. This can lead to discomfort in the area of the deltoid muscle with associated swelling and loss of function. A forced eccentric contraction of the shoulder (lengthening of the muscle belly while contracting), can lead to strain of the deltoid muscle (ie: doing a “negative” while weight lifting). Less commonly, a direct traumatic blow to the shoulder can cause a deltoid strain.

 

Deltoid strain symptoms

Deltoid strains are diagnosed by looking at the mechanism of injury and the symptoms the patient is having at the time of injury. A physical examination is imperative. Patients with deltoid strains can have pain with palpation of the involved area of the deltoid muscle belly. In more severe cases, with actual tears of the muscle, a palpable defect may be felt. The shoulder is also assessed for swelling and skin changes. Range-of-motion and strength testing are done to help confirm the diagnosis of a deltoid strain and rule out other possible diagnoses.

 

Imaging studies 

Depending on the mechanism of injury, no imaging studies may be needed. If there is concern for fracture or dislocation, radiographs of the shoulder may be indicated. Additionally, if there is concern for rotator cuff injury or a torn labrum, then a MRI of the shoulder, on rare occasions, may be necessary.

 

Different grades of deltoid strains 

Deltoid strains are graded based on the severity of the injury.

Grade 1 deltoid strains generally result in mild pain in the affected shoulder. Patients with grade 1 strains are able to use their shoulder and can lift their arms with minimal pain and are able to do push-ups without much difficulty. There will generally be minimal or no swelling.

Grade 2 deltoid strains are the next level of severity. This level of injury represents a partial tearing of the deltoid muscle. A patient with a grade II strain will have increased deltoid pain when lifting their arm. They may have difficulty doing push-ups or lifting their arm. There will generally be mild or moderate swelling.

Grade III strains are the most severe. A patient with a grade III strain typically has tearing of the deltoid muscle belly. The patients typically have severe pain and dysfunction in their arm. They are not able to use their arm for activities and will have moderate to severe swelling.

 

Treatment of deltoid strains 

In general, deltoid strains are treated conservatively. For Grade I injuries, generally little treatment is needed. Initially, most patients can benefit from sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation. Anti-inflammatory medications can be used to treat the pain symptomatically. Grade II injuries can be treated similarly. A brief period of physical therapy may be helpful to decrease pain and increase motion in the arm. Grade III injuries, the most severe, are treated with physical therapy and restricted activities. Consider shoulder bracing and shoulder ice packs for icing, protecting and resting the deltoid. Only on the very rare occasion would surgery be needed for a deltoid strain.

 

Deltoid strain K-Tape

 

 

Deltoid strain recovery time 

Depending on the severity of the strain, athletes healing time and return to sport can within in a day or two, or up to several weeks to months later. In order to safely return to athletic competition, the athlete must have regained all of their strength, as well as range of motion (ROM). After this has been regained, often sport specific exercises are initiated (such as a throwing program for the throwing athlete). Once the athlete is pain free, has full strength and ROM, and completed their sport specific exercises, if appropriate, then they may return to play without restriction. For minor, grade I, type injuries this can be done very quickly, whereas more severe grade III injuries may need several months of recovery. Return to play decisions should be determined under the guidance of a sports medicine professional and possibly an athletic trainer or physical therapist.

 

Getting a Second Opinion

A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options.  It will also provide you with peace of mind.  Multiple studies make a case for getting additional medical opinions.

In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.

You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions.  Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.

 

SportsMD’s Second Opinion and Telehealth Service

SportsMD offers Second Opinion and Telehealth appointments with a top sports medicine doctor to confirm a diagnosis and/or learn about different treatment options.

Please reach out to us at contactus@sportsmd.com if you need help finding a top sports doctor for a second opinion or Telehealth appointment in NY, NJ or CT.

We’ll do our best to connect you with a top sports medicine doctor who specializes in your injury area.

 

Find the Right Specialist for Deltoid Strain

SportsMD will help you find and schedule an in person or virtual Telehealth appointment. Tell us about yourself and your injury so we can match you with the doctor who best fits your individual needs.  contactus@sportsmd.com

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