Shoulder tendinitis is an inflammation and degeneration of the tendons in the shoulder area, which may lead to weakening and rupture of these tendons. The shoulder tendons, which include the rotator cuff and biceps tendons, help keep the head of the humerus (the upper arm bone) within the shoulder socket. The rotator cuff is made up of four muscles and their attaching tendons.

Causes

Tendons often become inflamed due to overuse, for example:

• Repeatedly reaching overhead

• Repeatedly throwing

In rare cases, falling on the arm can also cause tendinitis.

Bicipital tendinitis is often associated with rotator cuff conditions. Rotator cuff tendinitis may result from age-related changes due to wear and tear.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Risk factors for shoulder tendinitis include:

• Age: 30 and over

• Frequent use of the arm in an overhead position or throwing motion, as in:

• • Tennis or other racquet sports

• • Swimming

• • Baseball

• • Jobs such as overhead assembly work, butchering, or using an overhead pressing machine

Symptoms

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

Symptoms may include:

• Pain, usually 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. Special attention will be given to your shoulders, checking tender areas, range of motion, and muscle strength.

Tests may include:

• 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 – anesthesia is injected into the bursa overlying the rotator cuff tendons. If pain is relieved, this may help to confirm the diagnosis of tendinitis.

• Arthroscopy – 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 procedure is done under anesthesia. This is more likely to be done when a rotator cuff rupture is suspected.

Treatment

Therapy will depend on the extent of the injury, the cause, and other factors. Treatment may include:

• Rest – avoid activities that produce pain in the shoulder.

• Ice – to help 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 – may help 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 to 20 minutes at a time.

• • Protect your skin by placing a towel between the heat source and your skin.

• Medication, such as:

• • Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain; for example Aspirin or Ibuprofen (Motrin, Advil).

• • Steroid injection into the bursa overlying the rotator cuff to decrease the inflammation. Except for range of motion exercises, do not exercise the shoulder for 7 to 10 days after an injection.

• Rehabilitation, such as:

• • 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 – depending on the injury, different procedures can be used, including:

• • Arthroscopic surgery

• • Open technique

Prevention

Guidelines to help protect the shoulder from injury include:

• Do regular resistance exercises to strengthen the supporting 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.

• Modify 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.sportsmed.org

References:

Campbell's Operative Orthopaedics, 9th ed. Mosby Inc.; 1998.

Cecil Textbook of Medicine, 21st ed. W.B. Saunders Co.; 2000.

Emergency Medicine: Concepts and Clinical Practice, 4th ed. Mosby-Year Book Inc.; 1998.

Kelley's Textbook of Rheumatology, 6th ed. W.B. Saunders Co.; 2001.

Textbook of Primary Care Medicine, 3rd ed. Mosby Inc.; 2001.