by Wood D

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 connect near a joint. Tendinopathy is an injury to the tendon. It can cause pain and swelling and makes it difficult to move. Tendinopathy may be:
  • Tendonitis—inflammation of the tendon. (less common)
  • Tendinosis—tiny tears in the tendon with no significant inflammation. (more common)
There are several tendons in the shoulder. They are attached to muscles of the rotator cuff and the biceps muscle of the arm.
Shoulder Tendons
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Causes

Tendinopathy is generally caused by overuse of a muscle and tendon. Over time, the 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:
  • Inflammation disease in the shoulder such as arthritis
  • Trauma to the shoulder or fall on outstretched arms.
  • Normal wear and tear associated with age.

Risk Factors

Factors that increase your chance of developing shoulder tendinopathy include:
  • 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. Pain usually slowly increases with use.
Tendinopathy may cause:
  • 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. A physical exam will be done. Your doctor will check tender areas. Your shoulder range of motion, and muscle strength will also be checked.
Your doctor may need to get detailed images of your shoulder. This may be done if the injury is severe or to rule out other problems. Images can be taken with:
Bursitis can cause similar pain symptoms. Your doctor may inject an anesthetic medication. If the pain goes away it may suggest bursitis not tendinopathy.

Treatment

Tendinopathy and the associated pain may take months to resolve. It can be frustrating but it is important to follow through with recommended treatment. Treatments include:

Rest, Ice, Heat

Avoid activities that cause shoulder pain.
Use ice or an ice pak to help control pain and swelling, It may help during the first 24-48 hours after injury or after exercise. Protect your skin by placing a towel between the ice and your skin
After a few days, heat may help decrease stiffness. Check with a doctor or therapist before using heat the first time. Protect your skin by placing a towel between the heat source and your skin.

Medication

The doctor may recommend medication to help reduce swelling and pain. Medication options include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain (eg, aspirin or ibuprofen )
  • Topical pain medicines (eg, cream, patches) that are applied to the skin
  • Steroid injection into the bursa overlying the rotator cuff to decrease inflammation
Persistent or severe pain may need further treatment. Your doctor may inject a steroid into the area. It can temporarily relieve pain. However, frequent injections can damage the tendon.

Rehabilitation

Rehabilitation will help you regain strength and range of motion in your shoulder. It will also help you 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 modify 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 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.
  • Alter job duties 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

Bicpes tendinopathy. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated September 6, 2012. Accessed December 28, 2012.

Bursitis and tendonitis. National Institue of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Bursitis/default.asp . Accessed December 28, 2012.

Shoulder tendonitis. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/Tendonitis/hic%5FShoulder%5FTendonitis.aspx . Accessed December 28, 2012.

Rotator Cuff Tendonitis. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00032 . Accessed December 28, 2012.

10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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