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? 

The 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.

P.R.IC.E Treatment

Mild sprains can be treated with P.R.I.C.E.

Protection. The purpose of protection is to avoid further injury to the area by protecting the injured structures. The type of protection used varies depending on the injured area but may include a sling, protective tape, or over-the-counter brace.
Rest. Avoiding activities that put a lot of stress on your arm and shoulder is crucial to promote healing and prevent complications. If you have to use your arm or shoulder, you can use a shoulder brace or sling, which is shown to improve pai. Besides, you may use an over-the-counter pain medication to reduce pain and inflammation.
Ice. Ice can help reduce pain and swelling, as it numbs the affected shoulder and decreases blood flow to the area. Apply ice—wrapped in a damp towel— to the shoulder for 15 minutes at a time, 3 to 4 times a day.
Compression. Wrap the shoulder with an elastic bandage or a compression wrap to reduce swelling and support your shoulder. Avoid compressing too tightly. Doing so can impair circulation to the area. If the compressed area feels numb or tingly, loosen the bandage.
Elevation. Keep the injured shoulder above the level of the heart as often as possible.

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.

Anti-Inflammatory Protocol for Athletes

1. Nutrition Foundation

Focus on foods that naturally reduce chronic inflammation:

Daily

• Fatty fish (salmon, sardines, trout) 2–4x/week
• Extra virgin olive oil
• Colorful fruits and vegetables (berries, cherries, leafy greens)
• Nuts (especially walnuts and almonds)
• Avocados
• Beans and legumes

Limit

• Excess sugar
• Ultra-processed foods
• Excess alcohol
• Trans fats

2. Omega-3 Supplementation

Many sports medicine physicians recommend:

• EPA + DHA: 1,000–3,000 mg daily
• Take with meals

Potential benefits:

• Reduced muscle soreness
• Joint health support
• Lower systemic inflammation

3. Tart Cherry Protocol

Popular among endurance athletes.

Dose

• 8–12 oz tart cherry juice daily
  OR
• Concentrated tart cherry extract

Potential benefits:

• Reduced muscle soreness
• Improved recovery
• Better sleep quality

4. Curcumin (Turmeric Extract)

One of the most studied natural anti-inflammatory supplements.

Dose

• 500–1,000 mg/day of a high-bioavailability form

May help:

• Joint pain
• Tendon irritation
• Exercise-induced inflammation

5. Sleep Optimization

Sleep is arguably the most powerful recovery tool.

Targets:

• 7.5–9 hours/night
• Consistent bedtime
• Cool, dark room

Even one night of poor sleep can significantly increase inflammatory markers.

6. Recovery Training

Athletes often benefit from:

• Easy recovery runs/rides
• Walking
• Mobility work
• Light swimming

Recovery sessions increase circulation without adding substantial inflammation.

7. Hydration

Dehydration can worsen inflammatory responses.

General target:

• Pale yellow urine
• Increase fluids during heavy training or heat exposure

8. Cold Water Immersion (Use Strategically)

Research suggests:

• Helpful after competitions or tournaments
• Helpful when quick recovery is needed
• May reduce soreness

However, regular use immediately after strength training may blunt muscle growth adaptations.

9. Compression and Elevation

Useful for:

• Acute injuries
• Post-event swelling
• Long travel days

10. Supplements with Some Evidence

Commonly used in sports medicine:

What Many Sports Medicine Doctors Avoid

Routine use of high-dose NSAIDs (ibuprofen, naproxen) before workouts or races is generally discouraged because they can:

• Increase risk of kidney stress
• Increase GI bleeding risk
• Potentially impair healing of some tissues

Practical Recovery Protocol After a Hard Training Day

1. Protein: 25–40 g within a few hours.
2. Rehydrate with electrolytes.
3. Eat a meal rich in fruits, vegetables, and healthy fats.
4. Light walk or mobility session.
5. Tart cherry juice in the evening.
6. 8+ hours of sleep.

When to See a Sports Medicine Doctor

Everyday hundreds of athletes sustain suden trauma injuries – or an injury due to overuse. There are definately signs when you should seek an appointment with a sports medicine doctor to diagnose the injury and establish a treatment plan.  These signs can include:

• Swelling. Many sport injuries result in significant swelling of a joint, such as a ankle or knee. If the swelling is accompanied by bruising, tenderness, or a deformed limb, it could be a sign of a broken bone and time to see a doctor.
• Inability to Bear Weight or put pressure on the Joint. If you’re unable to bear weight or put pressure on a joint, you may have a serious orthopedic injury.
• Lingering Pain After a Period of Rest. Rest your body and injury for a week and if the pain still continues it’s time to see a sports medicine doctor.
• Inability to Move or Bend a Joint.  If you are unable to bend or move a joint, such as an ankle, elbow, wrist, shoulder, back  or knee, the cause is likely an orthopedic injury and you should seek care from a dooctor.

The deltoid is a muscle responsible for lifting the arm and helping the shoulder to move. Strains and injuries from overuse can lead to pain. In this article, learn about the types of deltoid strain, which range from mild to severe. https://t.co/bZMYspy0Ru pic.twitter.com/T833TlQ7JJ

— Dr. Amon Ferry (@amonferrymd) May 24, 2019