• Shoulder Tendinopathy

    (Shoulder Tendonitis; Shoulder Tendinosis; Bicipital Tendinopathy; Bicipital Tendonitis; Bicipital Tendinosis; Supraspinatus Tendinopathy; Supraspinatus Tendonitis; Supraspinatus Tendinosis; Pitcher's Shoulder; Swimmer's Shoulder; Tennis Shoulder)

    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
    factsheet image
    Copyright © Nucleus Medical Media, Inc.

    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.

    RESOURCES

    Arthroscopy Association of North America http://www.aana.org

    Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.org

    CANADIAN RESOURCES

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

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

    References

    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.

    Revision Information

  • LiveWell personal health survey

    How healthy are you really? Find out – free.Learn more

    It's time to stop guessing. If you want to make some changes but just aren't sure how, the free personal health survey from LiveWell is a great place to start.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease and prevent heart attacks. HeartSHAPE® is a painless, non-invasive test that checks pictures of your heart for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.