(Shoulder Tendonitis; Shoulder Tendinosis; Bicipital Tendinopathy; Bicipital Tendonitis; Bicipital Tendinosis; Supraspinatus Tendinopathy; Supraspinatus Tendonitis; Supraspinatus Tendinosis; Pitcher's Shoulder; Swimmer's Shoulder; Tennis Shoulder)
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:
- Tendinosis—tiny tears in the tendon with no significant inflammation (more common)
- Tendonitis—inflammation of the tendon (less common)
There are several tendons in the shoulder. They are attached to muscles of the rotator cuff and the biceps muscle of the arm.
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
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
- Certain jobs, such as overhead assembly work, butchering, or using an overhead pressing machine
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
You will be asked 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.
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
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. Move Forward—American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=6737f4e9-e8ec-43fe-b0b9-01e86354dcea#.VfG2WUW6n-Y, Updated December 19, 2013. Accessed September 16, 2015.
Biceps tendonitis and biceps rupture. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 5, 2015. Accessed September 16, 2015.
Bursitis and tendonitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health_Info/Bursitis/default.asp. Updated June 2013. Accessed September 16, 2015.
Rotator cuff tendonitis. Move Forward—American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=1bd18bbc-e7ea-436d-bc9e-ffee9c4dbd87#.VfG01UW6n-Y. Accessed September 16, 2015.
Swimmer's shoulder. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-shoulder-tendonitis. Updated March 27, 2015. Accessed September 16, 2015.
Shoulder impingement/rotator cuff tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00032. Updated February 2011. Accessed September 16, 2015.
10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Derry S, Moore R, et al H. Topical NSAIDs for acute musculoskeletal pain in adults. Cochrane Database Syst Rev. 2015 June 11;6:CD007402.
Last reviewed September 2015 by Laura Lei-Rivera, DPT
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.