Shoulder TendonitisBy Sally Ann Quirke | Filed under: Shoulder Pain, Tendonitis
Shoulder Tendonitis is a condition that I treat in various forms in my physiotherapy practice. Let’s start by looking at the “mechanics” behind this condition.
Your shoulder is a complex joint which is loose in its make up to allow for all those wonderful directions and ranges of movement that it performs. Your shoulder relies on your muscle and ligament systems to hold it in place and to move it. It is your shoulder muscles alone that are responsible for its movement.
The shoulder has many muscles and each individual muscle is attached to your shoulder bones by a soft tissue structure known as a shoulder tendon. A tendon does not contract and therefore is not responsible for moving your arm, but it is vital in its role of connecting your muscles to your bones. Because of a tendons connection to both the muscle and the bone it moves a lot!
Now, let’s talk about shoulder tendonitis!
What is Shoulder Tendonitis
Shoulder tendonitis is an inflammation of a tendon attaching to your shoulder. Although there are many tendons involved in your shoulder the most common cases of tendonitis that I see in my physiotherapy practice relate to the rotator cuff complex.
The rotator cuff is made up of four muscles that both stabilise and move your shoulder joint. Although I frequently see damage to these muscles and their attaching ligaments, more often I see their tendons in trouble. This tendon problem is often tendonitis.
Tendonitis commonly occurs in the hip and shoulders, and generally occur as a result of acute injury, overuse, or degeneration resulting from general aging. Shoulder tendonitis can cause a lot of pain and disability with your range of movement and daily use of your shoulder joint.
So, let’s now have a look at each one of these causes individually:
Injury: If you lift something heavy at an awkward angle you may strain or partially tear one of your rotator cuff tendons. As a result of this the tendon becomes inflamed, thickened and painful. Usually with adequate rest and treatment this will settle down within a few days to a week. However if it is not treated correctly it can become worse and last for a long time. The reason why it can worsen and last so long is due to the close positioning of the tendons to the bones of your shoulder joint. The architecture of your shoulder is amazing but it does not allow any space for a thickness in the tendon without it causing trouble!
Your thickened tendon gets pinched each time you move your arm in a certain way, and every time it gets pinched the injury worsens. So always seek help with acute shoulder pain to prevent yourself from developing chronic problems.
Overuse: If you overuse your shoulder regularly in a specific direction, over time you may develop a tendonitis. This is the most common cause of shoulder tendonitis that I see in my practice.
As your tendon becomes tired and overused it may develop a tear or a thickness as a result. Ultimately this form of tendonitis is more difficult to resolve unless the cause of the tendonitis is removed.
For many cases that I see this would involve a person stopping their work, or adjusting it greatly, which people find very hard to do. If you continue to use your arm in its painful movement it is very likely to get worse.
An interesting observation that I have seen is that: I have never seen the overuse form of shoulder tendonitis in an individual with good posture. Furthermore, I have encountered people who overuse their arms greatly for long periods of time and have no problems at all! These people always have a great posture! Interesting…..
So work on your posture if you use your arms a lot! Prevention is always better than cure!
- Degeneration: As you get older your tendons, like everything else, will gradually get weaker. If you continue to abuse them with overuse you may develop tendonitis. Other times it can be genetics that dictate where old age hits us in different ways, and tendonitis may be the one for you!
Treatment of Shoulder Tendonitis.
As with all mechanical injuries the priority is to remove the cause where possible. If you had a traumatic injury to your shoulder and developed tendonitis the cause is already removed. You should attend a specialised doctor and physiotherapist/physical therapist in this field immediately to ensure a good recovery. Never leave shoulder tendonitis to heal itself - it needs help!
Initially, I recommend rest, ice and anti-inflammatory medication. Then I use physiotherapy techniques to reduce the inflammation and thickness. Following this I advise on specific exercises to strengthen your shoulder, arm and neck. Allow 4-8 weeks depending on the severity of your tendonitis.
Some doctors advise cortisone injections to ease your pain. I believe these should be a last resort and should only be used where physiotherapy is having no effect after 2 weeks. Cortisone is a severe drug, but has its uses with shoulder tendonitis on occasion.
Jenny attended me four weeks ago with pain in her shoulder resulting from a game of tennis. Jenny had not warmed up on that day as she was rushing and it was in the first five minutes of her game that she felt a twinge of pain in her shoulder. She played on for an hour! The next day Jenny woke with a stiff and painful arm. She attended her doctor who prescribed anti-inflammatories and rest and advised her to come to see me three days later.
Examination confirmed a supra-spinatus tendonitis - inflammation of a tendon attached to one of the rotator cuff muscles. Jenny had a poor posture and her shoulders were rounded - especially on her injured side. I treated Jenny with taping and physiotherapy techniques twice a week for three weeks at which stage she was pain free with a full range of movement. She now attends a weekly Pilate’s class to help strengthen her shoulder and improve her overall posture. She returned to tennis in two more weeks and all is going well!
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