Tendonitis

Definition

The tendons connect muscle to bone and often near a joint. Tendinopathy is an injury to the tendon. It causes pain, inflammation, and makes movement difficult. Tendinopathy may be:

• Tendinosis—tiny tears in the tendon with no significant inflammation (more common)
• Tendonitis—inflammation of the tendon (less common)

There are several tendons in the shoulder.

Shoulder Tendons

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Causes

Tendinopathy is most often caused by overuse of a muscle and tendon. Over time, the regular strain on the tendon causes the structure of the tendon to change.

Shoulder tendons are overused most often with:

• Repeated reaching overhead
• Repeated throwing

Shoulder tendinopathy may also be caused by injury to the tendon from:

• Inflammatory disease in the shoulder, such as arthritis
• Trauma to the shoulder such as a fall on outstretched arms
• Normal wear and tear associated with age

Risk Factors

Shoulder tendinopathy is more common in people 30 years and older. It is also common in people that regularly use the arm in an overhead position or throwing motion such as:

• Tennis or other racquet sports
• Swimming
• Baseball
• Overhead assembly work, butchering, or using an overhead pressing machine

Symptoms

Symptoms will develop gradually over time. Pain may not always be present but slowly increases with use.

Common signs of shoulder tendinopathy include:

• Pain (a dull ache) in the shoulder and upper arm
• Pain at night, especially when sleeping on the injured side
• Pain when trying to reach for a back zipper or pocket
• Pain with overhead use of the arm
• Shoulder weakness, usually due to pain with effort
• Shoulder stiffness with some loss of motion

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor will check tender areas. Your shoulder range of motion, and muscle strength will also be checked. Most can be diagnosed based on your symptoms and physical exam.

If more damage is suspected or the diagnosis is unclear the doctor may order imaging tests. Tests may include MRI scan, x-rays, or CT arthrography.

Bursitis can cause similar pain symptoms. Your doctor may inject a medication that numbs pain. If the pain goes away, it may suggest bursitis not tendinopathy.

Treatment

Tendinopathy may take weeks or months to fully heal. Treatments include:

Rest

Full rest is usually not needed. Tendons do need a break from activities that are causing pain. A gradual return to normal activity will decrease the chance of damaging the tendon again.

Medication

Medications may help to manage pain and inflammation. Options may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical pain medications that are applied to the skin

Persistent or severe pain may need steroid medication. The medication is injected directly to the area. These injections can not be done often because frequent use can damage the tendon.

Rehabilitation

Rehabilitation will help regain strength and range of motion in the shoulder. It may also help to prevent future injuries. Rehabilitation may include:

• Physical therapy to strengthen muscles that control the shoulder
• Exercises to maintain normal range of motion
• Exercises for specific muscles that are used in sports or job activities
• Gradual return to sports and work
• Learning how to adjust activities to prevent re-injury

Surgery

Severe injuries may require surgery to repair the tendon. The type of surgery will depend on the specific injuries.

Prevention

To help reduce your chance of shoulder tendinopathy:

• Do regular resistance exercises to strengthen the muscles.
• Use proper athletic training methods.
• Do not increase exercise duration or intensity more than 10% per week.
• Avoid overusing your arm in an overhead position.
• Alter job duties to avoid overhead activity.
• Do not ignore or try to work through shoulder pain.