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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, causing pain, inflammation, and limited movement. 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
    factsheet image
    Copyright © Nucleus Medical Media, Inc.
  • 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:
    • Inflammatory disease in the shoulder, such as arthritis
    • Trauma to the shoulder
    • Fall on outstretched arms
    • Normal wear and tear associated with age
  • Risk Factors

    Shoulder tendinopathy is more common in people 30 years and older. Other factors that may increase your chance of shoulder tendinopathy include:
    • Always using the arm in an overhead position or throwing motion, as in:
      • Tennis or other racquet sports
      • Swimming
      • Baseball
      • Certain jobs, such as 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.
    Imaging tests used to evaluate your shoulder and surrounding structures may include:
    Arthroscopy is done with an instrument with a long tube and miniature camera on the end. Repairs or corrections can be made while the doctor evaluates the shoulder joint.
    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 an ice pack 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 pack 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.
    Shoulder tendinopathy can be treated with:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Topical pain medications that are applied to the skin
    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 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
    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.

    Arthroscopy Association of North America

    Ortho Info—American Academy of Orthopaedic Surgeons


    Canadian Orthopaedic Association

    Canadian Orthopaedic Foundation


    Biceps tendonitis and biceps rupture. EBSCO DynaMed website. Available at: Updated June 18, 2014. Accessed September 29, 2014.

    Bursitis and tendonitis. National Institue of Arthritis and Musculoskeletal and Skin Diseases website. Available at: Updated June 2013. Accessed September 29, 2014.

    Swimmer's shoulder. Cleveland Clinic website. Available at: Accessed September 29, 2014.

    Shoulder impingement/rotator cuff tendinitis. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: Updated February 2011. Accessed September 29, 2014.

    10/26/2010 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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