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Shoulder Tendonitis
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Shoulder Tendonitis

(Tendonitis, Shoulder; Rotator Cuff Tendonitis; Tendinitis, Shoulder; Shoulder Tendinitis; Bicipital Tendonitis; Impingement Syndrome of Rotator Cuff; Rotator Cuff Tendinosis; Subacromial Bursitis; Subdeltoid Bursitis; Calcific Tendonitis; Calcifying Tendonitis; Supraspinatus Tendonitis; Painful Arc Syndrome; Pitcher's Shoulder; Swimmer's Shoulder; Tennis Shoulder)

En Español (Spanish Version)

Definition

Shoulder tendonitis is when the shoulder tendons become inflamed and degenerate. This may cause them to weaken and rupture. The shoulder tendons (includes the rotator cuff and biceps tendons) keep the head of the humerus (the upper arm bone) within the shoulder socket. The rotator cuff is made of four muscles and their attaching tendons.

The Shoulder Tendons

factsheet image

© 2008 Nucleus Medical Art, Inc.

Causes

Tendons become inflamed due to overuse:

  • Repeatedly reaching overhead
  • Repeatedly throwing

In rare cases, falling on your arm can also cause tendonitis.

Bicipital tendonitis is linked to rotator cuff conditions. Rotator cuff tendonitis may result from wear and tear with age.

Risk Factors

These risk factors increase your chance of developing shoulder tendonitis. Tell your doctor if you have any of these risk factors:

  • Age: 30 and over
  • Always using the arm in an overhead position or throwing motion, as in:
    • Tennis or other racquet sports
    • Swimming
    • Baseball
    • Jobs (eg, overhead assembly work, butchering, or using an overhead pressing machine)

Symptoms

Symptoms develop gradually over time and pain slowly increases with use.

If you have any of these symptoms do not assume it is due to shoulder tendonitis. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • 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

The doctor will ask about your symptoms and medical history, and perform a physical exam. He will check tender areas, range of motion, and muscle strength.

Tests:

  • X-rays—a test that uses radiation to take a picture of structures inside the body, specifically the bones
  • MRI scan—a test that uses magnetic waves to make pictures of the inside of the body, in this case the tendons of the shoulder
  • CT arthrography—a type of x-ray that uses a computer to make pictures of the joint after a dye has been injected into the joint
  • Local anesthetic injection into the bursa overlying the rotator cuff tendons
    • This may confirm diagnosis if pain is relieved.
  • Arthroscopy—Done under anesthesia, a long, thin, fiberoptic tube with a light on the end is inserted through a small incision in the shoulder to look at the structures inside
    • This is more likely done if your doctors thinks you have a rotator cuff rupture.

Treatment

Treatments include:

Rest

Avoid activities that cause shoulder pain.

Ice

To control pain and swelling:

  • Use for 20 minutes at a time.
  • Use during the first 24-48 hours after injury or after exercise.
  • Protect your skin by placing a towel between the ice and your skin.

Heat

Heat may relieve pain and is often used before exercises to help with motion:

  • Do not use with acute pain or following acute injury.
  • Check with a doctor or therapist before using heat the first time.
  • Use for 15-20 minutes at a time.
  • Protect your skin by placing a towel between the heat source and your skin.

Medication

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain (eg, aspirin or ibuprofen (Motrin, Advil))
  • Steroid injection into the bursa overlying the rotator cuff to decrease inflammation
    • Except for range of motion exercises, do not exercise the shoulder for 7-10 days after an injection.

Rehabilitation

  • 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 modify activities to prevent re-injury

Surgery

Different procedures can be used depending on the injury:

  • Arthroscopic surgery
  • Open technique

Prevention

To protect the shoulder from injury:

  • 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.
  • Change job requirements to avoid overhead activity.
  • Do not ignore or try to work through shoulder pain.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org/

The American Orthopaedic Society for Sports Medicine
http://www.aossm.org/

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org/

Canadian Orthopaedic Foundation
http://www.canorth.org/

References:

Campbell WC, Canale T. Campbell's Operative Orthopaedics. 9th ed. Philadelphia, PA: Mosby, Inc.; 1998

Cecil RL, Goldman L, Bennett JC. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Co; 2000.

Impingement of the shoulder. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00032. Accessed June 22, 2008.

Marx J, Hockberger R, Walls R. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Philadelphia, PA: Mosby-Year Book Inc; 1998.

Noble J, Greene HL. Textbook of Primary Care Medicine. 3rd ed. Philadelphia, PA: Mosby Inc; 2001.

Ruddy S, Harris ED, Sledge CB, Kelley WN. Kelley's Textbook of Rheumatology. 6th ed. Philadelphia, PA: WB Saunders Co; 2001.



Last reviewed October 2007 by Robert E. Leach, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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