Shoulder tendinopathy refers to any tendon injury in your shoulder, whether it’s chronic or acute. This type of injury is usually caused by overuse. There are two types of tendon problems that can happen in your shoulder: Tendonitis and tendinosis.
Types of tendinopathy in the shoulder
- Tendonitis: Tendonitis occurs when overuse causes tendon wear and inflammation. This is an acute injury, meaning the pain is immediate, but it’s easily treated and damage is not permanent.
- Tendinosis: Tendinosis happens when your tendon begins to degenerate and small tears appear in the tissue. This injury is more serious and brought on by chronic overuse or a sudden force that overloads the tendon. In most cases, the shoulder condition begins as tendonitis and turns into tendinosis when left untreated.
Two joints make up the shoulder. Your acromioclavicular joint connects your shoulder blade (scapula) to your collarbone (clavicle). This joint allows you to raise your arm above your head. Your glenohumeral joint is a ball and socket joint. It connects the top of your upper arm, your humeral head (ball), to part of the scapula called the glenoid (socket). It gives you the ability to rotate your shoulder in a circle and move it up and out from your body.
Soft tissue like ligaments, cartilage, and tendons surround your glenohumeral joint. They help cushion the joint’s movement and keep the large humeral head in the shallow socket cavity.
Your rotator cuff is a group of tendons and muscles surrounding the top of the humerus to keep the head in place and allow your arm to rotate.
The deltoid muscle is the largest and strongest muscle in your shoulder. Tendons attach it to the clavicle and humerus and it provides you the strength to lift your arm.
Your bicep tendon connects the muscle on the front of your forearm to the top of your shoulder socket and allows your forearm to rotate and your elbow to bend.
What causes shoulder tendinopathy?
Tendinopathy is commonly caused by overuse. Repeated movement like reaching over your head or throwing a ball are examples of overuse. Your rotator cuff is the most common area for a tendon injury in your shoulder because it gives your arm the ability to move in a circular motion. Repeated arm rotation often causes rotator cuff tendinopathy in baseball, softball and volleyball players.
Other less likely causes of shoulder tendinopathy are the presence of arthritis or other diseases causing shoulder inflammation. A sudden fall or force to the shoulder could also cause strain on the tendons.
What are the symptoms of shoulder tendinopathy?
- Pain in the front of your shoulder
- Shoulder pain when reaching behind your back
- Shoulder pain when lifting your arm
- Shoulder pain at night when sleeping on your injured side
- Shoulder pain that is worse with use
- Shoulder weakness
- Shoulder stiffness
- Inflammation (tendonitis)
- Loss of range of motion
- “Clicking” sound when you raise your arm
When should I see a doctor for shoulder tendinopathy?
If you are experiencing pain or stiffness or you notice inflammation in your shoulder, you should make an appointment with a physician.
To determine whether you have shoulder tendinopathy your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. An X-ray or MRI may be necessary to confirm the diagnosis and determine if there are other problems.
How do you treat shoulder tendinopathy?
Shoulder tendinopathy will not heal on its own if you continue the activity causing it. Treating tendinopathy will include resting the affected tendon until your pain subsides.
Your physician will begin by prescribing nonsurgical treatment, which will reduce pain and improve function.
- Rest from all current activities
- Ice the inflamed or injured tendon
- Use heat to decrease stiffness
- Over the counter pain relievers
- Physical therapy exercises to increase range of motion
- Tissue and cell therapies*
- PRP injection*
- Surgery (Tendinosis)
As a last resort for tendinosis, your physician may suggest surgery. Your surgeon will perform your surgery arthroscopically, meaning they will make two small incisions and use a camera to repair your tendon.
*To avoid surgery, new studies show PRP and tissue and cell injections are an effective treatment to help ease pain caused by tendinopathy. Ask your physician if you’re a candidate for these orthobiologic therapies. These injections are not guaranteed to take effect, but when they work, they may help decrease pain and improve function.
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