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Shoulder tendonitis: Treating your shoulder injury

Shoulder tendonitis is inflammation that affects an area within the shoulder joint. The shoulder is kept stable by a group of muscles called the rotator cuff, as well as the biceps tendon. These muscles and tendons keep the upper arm bone (humerus) within the shoulder socket (glenoid). Shoulder tendonitis is an inflammation of your rotator cuff or biceps tendon. Your rotator cuff consists of the muscles and tendons in your shoulder. They connect your upper arm bone to your shoulder blade. Injuries may range from mild to severe inflammation of most of the rotator cuff. When your rotator cuff tendon gets inflamed and thickened, it is also called rotator cuff tendonitis. The rotator cuff tendon may get trapped under the top bone of the shoulder (acromion). It is formed by a part of the shoulder blade (the scapula). 

Imaging of the shoulder is often required to accurately diagnose shoulder tendonitis, the imaging modalities usually used include Ultrasound, MRI, and X-ray.

What causes shoulder tendonitis?

The shoulder is a ball and socket joint. The upper arm bone, the tendons of the rotator cuff that connect the bone to the muscles that lift the arm, and associated bursa (friction-reducing membranes) move back and forth through a very tight archway of bone and ligament called the coracoacromial arch. The condition often occurs in certain sports that require your arm to move over your head repeatedly. Such sports include baseball, weightlifting, volleyball, racket sports, and certain swimming strokes. Improper technique in any sport is one of the primary causes of overload on tissues, including tendons, which can contribute to tendonitis. People with jobs that require overhead work (e.g. assembly work or overhead pressing) or heavy lifting are also at risk of shoulder tendonitis. This is because when the arm is raised, as commonly done when throwing, swimming and playing racket sports, the archway becomes compressed against the tendons and bursa. Repetitive arm use causes the tendons and bursa to fray, resulting in inflammation and shoulder tendonitis pain.

What Are the Symptoms of Shoulder Tendonitis?

Shoulder tendonitis symptoms often include pain during movement. Other signs include:

  • Pain when raising or moving your arm is a simple shoulder tendonitis test that can signal inflammation
  • Stiffness in the shoulder
  • A shoulder described as tender or with mild swelling
  • A clicking sound in the shoulder
  • Reduced strength and mobility in the shoulder
  • Pain that never fades

What can affect the severity of symptoms?

Some of the contributing factors to the severity of shoulder tendonitis symptoms include:

  • Overuse – Repetitive overhead motion is the most common cause of rotator cuff degeneration
  • Weak muscles – When the rotator cuff muscles are weak, more force is exerted on the tendons and bursa by the action of the deltoid muscle
  • Improper technique — Improper/inappropriate swimming or throwing techniques can put stress on your muscles, tendons and tissues
  • Strenuous training – One hard throw, weight lift or workout may start the problem
  • Previous injury — Once you’ve had shoulder tendonitis, you are more likely to have a recurrence
  • Loose shoulder joint — Previous injuries can cause permanent damage to your shoulder, making tendonitis a recurring problem

Stages of Shoulder Tendonitis

Depending on the state of the present shoulder tendonitis, it can be found at different stages. These include:

Overuse tendonitis: Shoulder motions used during activities like golfing, throwing or overhead lifting may cause repetitive stress within the rotator cuff, leading to irritation, bruising or fraying of the tendon. This can cause shoulder tendonitis pain and weakness in the joint.

Calcific tendonitis: Inflammation over a long period can sometimes result in a build-up of calcium deposits within the rotator cuff tendons. This leads to pain and loss of shoulder strength and motion.

Rotator cuff tear: Severe tendonitis from fraying or degeneration, or a sudden injury, such as a fall, can cause partial or complete tearing of the rotator cuff tendon(s). This can result in more severe shoulder pain, weakness, loss of normal movement and awakening at night due to pain. Learn more about how we treat rotator cuff tears.

Shoulder Tendonitis Treatment

Treatment of shoulder tendonitis can vary based on certain factors. Healthcare providers often assess a range of aspects in order to decide which treatment option, or combination of treatment options, is best for the injury. But generally, treatment will include the following:

Rest: Avoid activities that cause pain, especially if the pain is worse the next day. Avoid the activity that started the problem. Do not use the arm repeatedly out to the side of the body.

Cortisone injection: An anti-inflammatory pain medication to relieve pain and inflammation can be effective as shoulder tendonitis is from the inflammation of part of the shoulder. A healthcare provider may recommend an injection of cortisone with lidocaine into the shoulder bursa. Ultrasound is used to pinpoint the best place for the injection and a mix of anaesthetic and cortisone is injected. The anaesthetic provides immediate relief until the cortisone has time to work. If you receive an injection, do not use the shoulder for vigorous activities for about two weeks.

Many physios may recommend a cortisone injection in conjunction with physiotherapy exercises to help speed up the process, or if the physiotherapy alone is not having much of an effect. Cortisone injections can be had up to 3-4 times a year in the same area, depending on the affected area. 

Physiotherapy: Physiotherapy is often a recommended route of treatment by healthcare providers for shoulder tendonitis. Regular exercise to strengthen the shoulder may help to prevent a recurrence. Physiotherapists can help personalise a treatment plan to help ease the symptoms of shoulder tendonitis.

Ice: Apply an ice bag (over a towel) to your shoulder at least twice a day for 20 minutes. Also, apply ice after any activity that aggravates your shoulder pain.

Surgery: Orthopaedic surgery may be required to treat shoulder tendonitis and bursitis if it becomes chronic or if there is a tear of the rotator cuff. Your healthcare provider will discuss this with you as an option.