(Shoulder Tendonitis; Shoulder Tendinosis; Bicipital Tendinopathy; Bicipital Tendonitis; Bicipital Tendinosis; Supraspinatus Tendinopathy; Supraspinatus Tendonitis; Supraspinatus Tendinosis; Pitcher's Shoulder; Swimmer's Shoulder; Tennis Shoulder)
Tendinopathy is an injury to the tendon. It can cause pain, swelling, and limit movement. The injuries can include:
- Tendonitis—an inflammation of the tendon. (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
- Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation.
There are several shoulder tendons including the rotator cuff and biceps tendons. These tendons keep the head of the humerus (the upper arm bone) in the shoulder socket. Tendinopathy and the associated pain may take months to resolve.
The Shoulder Tendons
Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon itself.
Shoulder tendons are overused most often with:
- Repeated reaching overhead
- Repeated throwing
Bicipital tendinopathy is linked to rotator cuff conditions. Rotator cuff tendinopathy may result from wear and tear with age.
Normal Rotator Cuff
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
- Jobs (eg, overhead assembly work, butchering, or using an overhead pressing machine)
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 tendinopathy. 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
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will check tender areas, range of motion, and muscle strength.
For severe symptoms or to rule out other problems your doctor may order:
- X-rays]]> —a test that uses radiation to take a picture of structures inside the body
- ]]>MRI scan]]> —a test that uses magnetic waves to make pictures of the inside of the body,
- 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.
—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.
Treatments include :
Avoid activities that cause shoulder pain.
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 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.
- 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
]]>Different procedures can be used]]> depending on the injury:
- Arthroscopic surgery
- Open technique
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.
American Academy of Orthopaedic Surgeons
The American Orthopaedic Society for Sports Medicine
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
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 September 2009 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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