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Shoulder Tendinopathy

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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 you regain strength and range of motion in your 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.

Revision Information

  • Arthroscopy Association of North America

    http://www.aana.org

  • Ortho Info—American Academy of Orthopaedic Surgeons

    http://orthoinfo.org

  • Canadian Orthopaedic Association

    http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

  • Biceps tendonitis. Move Forward—American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=6737f4e9-e8ec-43fe-b0b9-01e86354dcea#.VfG2WUW6n-Y, Updated December 19, 2013. Accessed September 16, 2015.

  • Biceps tendonitis and biceps rupture. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114474/Biceps-tendonitis-and-biceps-rupture. Updated February 5, 2015. Accessed September 16, 2015.

  • Bursitis and tendonitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Bursitis/default.asp. Updated June 2013. Accessed September 16, 2015.

  • Rotator cuff tendonitis. Move Forward—American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=1bd18bbc-e7ea-436d-bc9e-ffee9c4dbd87#.VfG01UW6n-Y. Accessed September 16, 2015.

  • Swimmer's shoulder. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-shoulder-tendonitis. Updated March 27, 2015. Accessed September 16, 2015.

  • Shoulder impingement/rotator cuff tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00032. Updated February 2011. Accessed September 16, 2015.

  • 10/26/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114474/Biceps-tendonitis-and-biceps-rupture: Derry S, Moore R, et al H. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev. 2015 June 11;6:CD007402.

The health information in this Health Library is provided by a third party. Cartersville Medical Center does not in any way create the content of this information. It is provided solely for informational purposes. It does not constitute medical advice and is not intended to be a substitute for proper medical care provided by a physician. Always consult with your doctor for appropriate examinations, treatment, testing, and care recommendations. Do not rely on information on this site as a tool for self-diagnosis. If you have a medical emergency, call 911.