Definition

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.

Causes

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

Risk Factors

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
  • Swimming
  • Baseball
  • Certain jobs, such as overhead assembly work, butchering, or using an overhead pressing machine

Symptoms

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

Diagnosis

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:

• MRI scan
• X-rays
• CT arthrography

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.

Treatment

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:

Prevention

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.

Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.org

Canadian Orthopaedic Foundation http://www.canorth.org

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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:
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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.

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