Shoulder Tendonitis

Shoulder tendonitis is an inflammation of the tendons around the shoulder joint. Tendons are tough, flexible bands that connect muscles to bones. In this case, the tendons affected are those around the shoulder, especially those of the rotator cuff muscles and the biceps tendon.

The inflammation usually results from repetitive movements, overuse, or injury, which cause irritation and swelling in the tendons. This swelling can lead to:

• Pain when moving the shoulder.
• Stiffness that limits the range of motion.
• Sometimes a feeling of weakness or instability in the shoulder.

The most common symptoms of shoulder tendonitis are the following:

• Pain during shoulder movement or when lifting the arm.
• Tenderness around the front or side of the shoulder.
• Possible swelling and warmth if inflammation is significant.
• Reduced range of motion and stiffness.

The effective treatment of shoulder tendonitis requires immediate interventions.

The conservative (non-surgical) treatment includes: 

• Rest: Avoid activities that aggravate the pain.
• Physical Therapy: Customized exercises to improve flexibility, strength, and shoulder stability.
• Strengthening Exercises: Focus on rotator cuff and scapular muscles to support the shoulder.
• Anti-inflammatory Medications: Such as NSAIDs to reduce pain and swelling, generally used for short-term relief.

The surgery is needed if symptoms persist despite conservative treatments and in cases of severe tendon damage, tears, or chronic inflammation. Surgery may involve repairing the damaged tendons or removing inflamed tissue to restore function and relieve pain.

The most common cause of shoulder tendonitis is excessive strain and repeated micro-injuries to the tendon.

Other causes that can lead to shoulder tendonitis include:

• The coexistence of impingement syndrome
• Acute injury: sudden injury like a fall, a direct blow, or a sudden forceful movement can damage the tendons causing immediate inflammation.
• Incorrect technique in sports that involve repetitive overhead motions such as swimming, volleyball, tennis, and basketball
• Repetitive lifting or prolonged overhead use: Occupations or activities requiring repeated lifting or keeping the arm raised for long periods increase stress on shoulder tendons.
• Intense training: Overtraining without adequate rest reduces the tendons’ ability to repair themselves, increasing injury risk.
• Falls on the shoulder or outstretched arm: trauma from falls can cause sudden tendon injuries or damage supporting structures, contributing to tendonitis.
• Poor posture: rounded shoulders or a forward head position change the alignment of the shoulder joint and increase strain on the tendons.
• Shoulder anatomy: some people have anatomical differences like bone spurs or a narrow space in the shoulder joint, increasing the likelihood of tendon compression.
• Age: tendons lose elasticity and become less resilient with age, making them more prone to injury and slower to heal.
• Daily, prolonged use of the computer: repetitive movements and static postures, like typing or mouse use, can cause subtle shoulder strain over time.

Shoulder tendonitis can cause various complications, especially if it is not treated promptly and properly. Some of the complications that may arise include the following:

• Chronic pain: When shoulder tendinitis is left untreated or improperly managed, inflammation of the tendons can persist over time, leading to chronic tendinitis. This results in ongoing discomfort that may not fully go away. Chronic pain can affect overall quality of life by limiting physical activities and causing discomfort even during rest.
• Pain during the night: Tendinitis often causes a deep, aching pain that can worsen when lying down or trying to sleep. The inflammation and irritation of the tendons can become more noticeable at night. Sleep disturbances can lead to fatigue, irritability, and reduced healing capacity, making recovery more difficult.
• Loss of functionality: The shoulder joint is highly mobile and relies heavily on tendons for movement and stability. Tendonitis can cause swelling, stiffness, and pain that limit the range of motion. This can make simple daily tasks like reaching overhead, lifting objects, combing hair, or dressing difficult, impacting independence.
• Loss of muscle strength: Prolonged inflammation and pain often result in reduced use of the affected shoulder, which can lead to muscle atrophy (weakening and shrinking of muscles). Decreased strength in the shoulder and upper arm can further impair movement and increase the risk of injury.

It is important to address shoulder tendonitis in its early stages and follow the doctor’s advice for treatment to avoid possible complications.

Shoulder tendonitis typically develops due to repetitive overhead motions or overuse, such as:

• Repeated lifting or throwing
• Sports activities like swimming, tennis, or baseball
• Occupations involving frequent arm elevation (e.g., painting, construction)
• Poor posture or muscle imbalances
• Aging and degeneration of the tendon tissue

Pain usually starts mildly and worsens gradually. Early symptoms may be ignored, but persistent irritation leads to more noticeable discomfort. The main symptoms of shoulder tendonitis are:

Pain When Raising the Arm Overhead: Tendons become compressed or inflamed when the arm is lifted, especially above shoulder height, causing pain.

Pain Lying on the Arm or Lifting Objects: Pressure on the inflamed tendons (e.g., lying on the affected shoulder) or using the arm with an extended elbow can aggravate symptoms.

Pain When Moving the Arm behind the Head or Back: Certain shoulder movements stretch or pinch the tendons, causing discomfort.

Pain Radiating to the Elbow: This is more common if the biceps tendon is involved, as the biceps muscle runs from the shoulder to the elbow.

Resting Pain: When tendonitis worsens and remains untreated, pain can occur even at rest or at night, disrupting sleep.

Swelling and Inflammation: The front of the shoulder might appear swollen or tender due to inflammation.

Weakness and Limited Movement: Pain and inflammation can lead to difficulty moving the arm, reducing strength and functional use.

Diagnosing shoulder tendonitis typically involves several steps to confirm the condition and rule out other possible causes of shoulder pain:

• • Clinical Symptoms:
    • Patients usually report pain localized around the shoulder, especially with certain movements like lifting the arm sideways or overhead.
    • There might be stiffness or a feeling of weakness in the shoulder.
  • Medical History:
    • The doctor will inquire about recent activities, injuries, or repetitive movements that might have strained the shoulder tendons.
    • Pre-existing conditions or previous shoulder injuries may also be discussed.
  • Physical Examination:
    • The doctor will test the range of motion, strength, and pinpoint areas of tenderness.
    • Specific tests may help identify which tendon is affected.
  • Imaging Studies:
    • X-ray: Primarily used to rule out bone abnormalities like fractures or arthritis, since it cannot show soft tissues clearly.
    • Magnetic Resonance Imaging (MRI): Provides detailed images of soft tissues, including tendons and muscles. MRI can detect inflammation, tendon tears, or degeneration.
    • Ultrasound: A dynamic, less expensive option that allows real-time visualization of tendons during movement. It’s useful to see tendon inflammation or tears.

The tendon most commonly affected in the shoulder area is the supraspinatus (Supraspinatus Tendonitis) that is part of the rotator cuff, a group of muscles and tendons stabilizing the shoulder. Patients may experience pain and limited movement especially when lifting the arm sideways (abduction) and may lead to weakness or limited range of motion.

Additionally, the overuse of the biceps tendon, which plays an important role in lifting heavy objects, can make it susceptible to tendonitis (Biceps Tendonitis). This can cause pain at the front of the shoulder and difficulty moving the arm and shoulder normally.

The early treatment of shoulder tendonitis is crucial to prevent the condition from worsening into a tendon rupture, which is a more severe injury requiring surgery and longer recovery. The goal of treatment is to reduce pain and inflammation, maintain shoulder strength and range of motion (ROM), and prevent long-term damage. In the early stages of shoulder tendonitis symptoms, rest and modification of the patient’s activities are recommended, along with the use of painkillers and anti-inflammatory drugs, which often lead to pain relief. Ice does not significantly relieve shoulder tendonitis symptoms and is not recommended. This is notable because ice is often used for soft tissue injuries, but research suggests its benefits for tendonitis specifically may be limited.

If the symptoms of shoulder tendonitis persist, technique improvement in athletes, physical therapy, local corticosteroid injections, or biological factor injections (PRP) are required.

Exercises to improve shoulder strength and mobility are essential but must be supervised by an experienced physiotherapist. Incorrect exercises or overdoing them may worsen symptoms or cause further injury.

Exercises for shoulder tendonitis should always be done under the guidance of an experienced physiotherapist. Otherwise, symptoms may worsen.

Local injection of biological factors like Platelet-Rich Plasma (PRP) in shoulder tendonitis has proven very effective in recent years and they are the first-line treatment choice in managing shoulder tendonitis.

Initially, shoulder tendonitis is usually managed with non-surgical options such as physical therapy, anti-inflammatory medications, corticosteroid injections, and activity modification. If these do not relieve symptoms or if the condition worsens, surgical intervention becomes necessary. The preferred method is shoulder arthroscopy. It is a minimally invasive surgical technique that involves the use of a small camera (arthroscope) and specialized instruments inserted through two tiny incisions (less than 1 cm). It is performed under general anesthesia and usually takes about 30 minutes. The surgeon can visualize the inside of the shoulder joint in real time. It doesn’t require hospitalization and the patient quickly returns to his/her daily activities without further discomfort.

Dr. Panagiotis Pantos is a specialized Orthopedic Surgeon in Shoulder Arthroscopy and Sports Medicine, focusing specifically on the upper limb (shoulder, elbow, hand).

He has extensive experience and he was trained in Germany, where he served as Deputy Director of Orthopedics – Traumatology at the Shoulder Surgery Clinic, Klinik Maingau vom Roten Kreuz, a recognized clinic in Frankfurt with a strong reputation in musculoskeletal medicine.

Since 2020, he has been the Director of the Upper Limb Department at the Athens Medical Group (AMG), in a clinic with top specialists in all orthopedic subspecialties.

He has been surgical expertise in shoulder disorders and he has performed more than 2.500 shoulder arthoscopies, targeting chronic shoulder issues, ensuring:

• Optimal outcomes
• Pain relief
• Restored mobility and
• Improved quality of life

When Should I See a Doctor?

The earlier you get professional advice, the better your chances of avoiding worsening pain or long-term damage.

Red flags to watch for:

• Increasing pain that doesn’t improve with rest
• Limited range of motion or difficulty moving the shoulder
• Pain severe enough to disturb sleep
• Numbness, tingling, or weakness in the arm or shoulder, which could indicate nerve involvement or more serious injury

Can I Treat Shoulder Tendonitis On My Own?

While some home care, like rest and ice, can help manage shoulder tendonitis, a doctor’s guidance is essential for proper diagnosis and treatment. Conservative treatment typically involves rest, avoiding aggravating activities (repetitive movements that strain the shoulder), ice, pain medication, and physical therapy.

Can I Exercise Normally During Shoulder Tendonitis?

It is generally not recommended to exercise normally during shoulder tendonitis, as certain activities and exercises can exacerbate the condition. It’s crucial to consult with a doctor or physical therapist for personalized advice on exercise during recovery. He may recommend rest, specific exercises, and activity modifications to promote healing and prevent further injury.  

How Long Does It Take To Recover From Shoulder Tendonitis?

The recovery time depends on the severity of the condition. Mild cases may improve within a few weeks, while more severe or chronic cases can take several months. Recovery is faster and more effective when the condition is treated properly, which may include rest, ice, anti-inflammatory medications, physical therapy, and sometimes injections. However, tt also depends on how well you avoid aggravating the injury during healing.

Are There Ways To Prevent Shoulder Tendonitis?

Yes, there are several ways to help prevent shoulder tendonitis. These include avoiding activities that strain the shoulder, improving posture, strengthening shoulder muscles, and using correct technique during sports. 

Do I Need Surgery For Shoulder Tendonitis?

Surgery is usually considered only if non-surgical (conservative) treatments fail to improve symptoms. Conservative treatments include rest, anti-inflammatory medications, physiotherapy, and sometimes steroid injections. If the pain persists, or if there is significant damage such as a tendon tear or severe inflammation that doesn’t heal, surgery may be recommended to repair the tendon or remove damaged tissue.

What Is The Role Of Physiotherapy In The Treatment Of Shoulder Tendonitis?

Physiotherapy can help relieve pain, strengthen the shoulder muscles, and improve mobility.

Physiotherapists often advise on posture, ergonomics, and activity modification to avoid aggravating the tendon.

Can Shoulder Tendonitis Return After Recovery?

Yes, shoulder tendonitis may come back, especially if the underlying causes aren’t addressed. These causes can include repetitive overhead activities, poor posture, inadequate muscle strength, or improper technique in sports or work tasks. Following the doctor’s advice and strengthening the shoulder muscles can reduce the risk of recurrence.

How important is it to follow the treatment and the doctor’s advice?

Regular adherence to the treatment and the doctor’s advice is critical for recovery from shoulder tendinitis. Shoulder tendonitis is inflammation or irritation of the tendons around the shoulder joint. Proper treatment often involves rest, medication, physical therapy, and sometimes lifestyle changes. Following the doctor’s instructions closely helps ensure that the inflammation reduces and the tendon heals correctly. When you stick to the treatment plan, recovery tends to be faster and more complete, allowing you to regain normal shoulder function and avoid complications. Ignoring advice or not completing treatment can lead to prolonged pain, worsening of the condition, and increased risk of the tendonitis coming back or turning into a chronic problem.