The rotator cuff is an important group of muscles and tendons that connect the upper arm bone (humerus) to the shoulder blade (scapula). It provides stability to the shoulder joint and allows it to move and rotate. Rotator cuff tendonitis, commonly referred to as shoulder tendonitis, is a condition in which any of these tendons-thick bands of tissue that connect muscles to bones-becomes inflamed or irritated. Along with shoulder bursitis, shoulder tendonitis is a frequent cause for shoulder complaints, and it's the most common condition responsible for shoulder pain in people over the age of 40.
What causes shoulder tendonitis?
The rotator cuff consists of four separate muscles, each of which has a tendon that attaches to different parts of the shoulder blade. These tendons form a "cuff" around the head of the humerus, and the muscles of this group work together to control and stabilize the shoulder. As a ball-and-socket joint, the rotator cuff helps secure the "ball" portion of the shoulder as the arm moves and rotates within the socket. Shoulder tendonitis occurs when these tendons are injured and become inflamed as a result.
The most common cause of shoulder tendonitis is overuse of the shoulder. This means the tendons in the rotator cuff are overworked beyond what they can handle, and over time they eventually become damaged. In most cases this occurs from participating in certain sports and overhead activities that require the arm to move over the head repeatedly. Swimmers, golfers and baseball players, as well as painters and people with jobs that involve heavy lifting are especially prone to getting shoulder tendonitis. Those who don't use proper form while performing these activities are at an even greater risk. Other risk factors that can increase the chances of developing shoulder tendonitis include:
- Poor posture, such as rounded shoulders, which some people get from leaning over a computer for extended periods of time
- Tight muscles and tissues around the shoulder joint
- Weakness or imbalance of the muscles in and around the shoulder
- In rare cases, a direct blow to the shoulder or falling on an outstretched hand may also cause shoulder tendonitis
***Note that the terms shoulder impingement syndrome and shoulder bursitis are sometimes used with shoulder tendonitis. All conditions are related and may occur together, but they each describe a different problem with the shoulder.***
What are the symptoms?
- The most common symptom of shoulder tendonitis is pain and possibly swelling at the tip of the shoulder and upper, outer part of the arm
- This pain often gets worse if you reach, lift, pull, push or lie on your side; this can make it difficult to sleep comfortably if you roll or sleep on your shoulder
- There may also be a "clicking" sensation when you reach your arm above your head
- Some patients also experience stiffness and loss of mobility and/or strength
What is the treatment?
If you start to notice symptoms of shoulder tendonitis and the pain is preventing you from functioning normally for more than a week or two, you should see a doctor or physical therapist as soon as possible. Most cases of shoulder tendonitis are very treatable, but the sooner you seek out treatment, the greater your chances of recovering. To diagnose your condition, he or she will ask you questions about your symptoms, conduct a physical examination and perform strength and motion tests on your shoulder. X-rays and other tests are not usually needed, but they also may used to determine if any other conditions are also present.
If you address your shoulder tendonitis early enough, conservative (non-surgical) treatment is usually successful for addressing your condition. Some basic home remedies you can follow on your own are:
- Rest: avoid any activities that make your symptoms worse, including overhead motions and reaching aggressively in any direction
- Ice: apply an ice pack or cold compress to the upper and outer portion of the shoulder for 15-20 minutes every 4-6 hours; the HyperIce Shoulder Ice Wrap allows you to ice your shoulder while still functioning normally
- Posture: try to maintain proper posture-especially for your shoulders-while sitting and at all other times to reduce strain on the arms
Conservative treatment may also include physical therapy if you see a physical therapist right away or if your doctor recommends it. Your physical therapy program will depend on your age, abilities and how severe your condition is, but the goal is always to reduce pain and improve function so you can get back to your normal activities. Some of the most effective components of physical therapy are:
- Strengthening exercises: these types of exercises, which may use weights, medicine balls or resistance bands, will help to restore the normal functioning of your shoulder and prevent future injury
- Manual therapy: your therapist may use a variety of hands-on techniques like gentle joint movements, massage and shoulder stretches to improve the movement of your shoulder
- Stretching exercises: since your shoulder's range-of-motion, or flexibility will be impaired, these exercises will help it move more properly
- Support: your therapist may prescribe that you wear a sling or tape your shoulder to prevent too much movement and provide relief
- Braces: depending on how serious your tendonitis is, a brace may also be needed for additional stability; the Saunders DonJoy Sully Shoulder Brace and DonJoy Shoulder Stabilizer are bracing options
- Education: your therapist will work with you to help you improve your posture and avoid any movements and habits that can make your pain worse
- Functional training: if you're an athlete in an overhead sport or regularly perform overhead motions, your therapist will provide specific training to help reduce the chance of further injury
If you don't experience much relief from these treatments, an injection may be prescribed. This is usually a steroid that's injected directly into the shoulder, which is effective for temporarily reducing pain in some patients. If the injection is successful, it can be repeated once a month for three months.
Only extreme circumstances will require the consideration of surgery. If you're still in pain after attempting all of these conservative treatments, or if you've completely torn your rotator cuff, you should speak with your doctor about the option of surgery. If you determine that it's right for you, the procedure will repair the damage in the rotator cuff, either with open surgery or a minimally invasive procedure. Extensive rehabilitation will be needed afterwards.
Can shoulder tendonitis be prevented?
Since most cases of shoulder tendonitis are due to overworking the shoulder, the best way to reduce your chances of developing it are to avoid or modify activities that put too much strain on the shoulder. Following these tips can help:
- If you're an athlete in an overhead sport or your occupation requires these movements, make sure you're using proper form at all times and try to take frequent breaks to rest your shoulder
- Warm up and stretch the shoulder before engaging in physical activities, especially if overhead movements are necessary
- Maintain proper posture during your daily activities, especially when sitting
- Keep your upper body strong, especially your upper back and shoulders
- Stay flexible in your upper body as well; perform shoulder stretches to keep limber