Explore Shoulder Tendonitis
What Is Shoulder Tendonitis?
Shoulder tendonitis, also called rotator cuff tendonitis, results from inflammation of your rotator cuff or biceps tendon. Tendonitis in the shoulder results when inflammation pinches or traps the tendon against bones. Shoulder tendonitis pain—usually felt at the tip of the shoulder or radiating down the arm—commonly occurs when the arm is lifted overhead or twisted. Symptoms can range from mild stiffness to severe pain.
Shoulder Tendonitis Causes
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.
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’s the Difference between Shoulder Bursitis vs Tendonitis?
Bursitis occurs when the bursa becomes inflamed and painful due to compression inside the coracoacromial arch. Shoulder tendonitis occurs when a rotator cuff tendon becomes irritated, inflamed or partially torn. Symptoms of tendonitis and bursitis usually last for only a few days but may recur or become chronic.
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
- 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 Tendonitis in the Shoulder
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.
How Is Shoulder Tendonitis Diagnosed?
To best diagnose shoulder tendonitis, a specialist may start with a physical exam, discuss recent injuries as part of a medical history, and evaluate symptoms. From there, additional tests may include:
- X-ray creates images of internal tissues, bones and organs
- Ultrasonography uses sound waves to produce pictures of tissues and organs
- MRI uses magnets and radio waves for detailed images of internal organs and tissues
Shoulder Tendonitis Treatment
Treatment of shoulder tendonitis can vary based on certain factors. 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.
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.
Medication: An anti-inflammatory pain medication (such as Advil, Aleve or aspirin) to relieve pain and inflammation. A doctor may recommend an injection of cortisone with lidocaine into the shoulder bursa. If you receive an injection, do not use the shoulder for vigorous activities for about two weeks.
Surgery: Surgery may be required to treat shoulder tendonitis and bursitis if it becomes chronic or if there is a tear of the rotator cuff.
Learn more about how Mass General Brigham specialists diagnose and treat a full spectrum of shoulder injuries.
Physical Therapy for Shoulder Tendonitis
Your surgeon may send you to a physical therapist for exercises or other treatment. Exercises to strengthen the shoulder may help to prevent a recurrence. Learn more about what our Sports Physical Therapy Service has to offer.
Stretching exercises can be done to help restore shoulder range of motion. Each stretch can be done to the point of a comfortable feeling of stretch and should be done slowly to allow the muscles and soft tissues time to lengthen. Hold each stretch for 15 to 20 seconds. When stretching, your goal is to reach the maximum range of motion for you. It is recommended that you warm-up well before stretching.
Generally, you should do some walking, cycling or jogging so that you break a sweat before you start stretching. Allow the first one or two repetitions to be warm-up reps, with little or no pain.
Gradually work into more and more range of motion as you begin to feel more flexible. Mild pain while stretching sometimes occurs, however it is not recommended that you “push through the pain”. If you are patient, the arm will become looser as it warms-up. Do 5 to 10 repetitions, 2 or 3 times a day.
Theraband Strengthening for the shoulder: These resistance exercises should be done very slowly in both directions. The goal is to achieve a maximum amount of strengthening while listening to your end-point of pain. Work within a pain free range of motion at all times and do the exercises very slowly. The slower the motion, the better the muscle contraction is throughout the range of movement.
Rotator Cuff and Scapular Strengthening Program: The rotator cuff and scapular exercises are intended to isolate the essential muscles of the shoulder that provide strength to the rotator cuff and control the scapula (shoulder blade). Each exercise should be done for one set of 15 repetitions prior to a weight training workout or 2-3 times a week for good shoulder strength and muscle balance. Weights used with these exercises can be built up gradually in increments of no more than 1 pound per week, with a safe limit of 5 lb.
Return to Sports
General principles: Rest the shoulder until your symptoms clear. When you go back to your sport, go back slowly. Warm-up well and do flexibility exercises before starting. Avoid the overhead position and do not play excessively long. Gradually increase the intensity of your activity.
Throwing sports: Initially, an underhand or sidearm throw will be easier than an overhand throw. Warm-up well. Throw easily and gradually increase to harder throwing. Try to maintain a smooth throwing motion that uses your body's overall strength.
Swimming: Breaststroke or sidestroke will be easier than crawl or butterfly strokes. Sometimes the back-stoke is permitted. Be sure that your swimming mechanics and style are correct.
When should I see a doctor for my shoulder pain?
If your shoulder pain lasts for more than a few weeks, doesn't start improving within a couple of weeks or starts getting worse, we recommend visiting a doctor. Request an appointment today with one of our specialists.
How long does shoulder tendonitis last?
Shoulder tendonitis can start to heal within two to four weeks for a relatively minor case but can take months in other situations.
What is the best treatment for shoulder tendonitis?
Shoulder tendonitis treatment varies based on individual factors, but standard care includes rest, nonsteroidal anti-inflammatory drugs, physical therapy and strengthening exercises, cortisone injections and possibly surgery.
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