(Also known as: tendinitis or tendinopathy)
Shoulder tendonitis (or tendinitis) is an inflammation injury to the tendons of your shoulder’s rotator cuff. Inflammation is not always present in injuries to the shoulder tendons, so this group of injuries are medically known as a rotator cuff tendinopathy.
What causes it?
The most common cause of shoulder tendonitis is repeated micro trauma to the rotator cuff tendons, rather than a specific one-off trauma.
Rotator cuff impingement, where your rotator cuff tendon impacts against the acromion bone, should not occur during normal shoulder function. However, when repeated shoulder impingement occurs, your rotator cuff tendon becomes inflamed and swollen. This is what results in shoulder tendonitis.
What are the symptoms?
Shoulder tendonitis commonly has the following symptoms:
• Shoulder clicking and/or an arc of shoulder pain when your arm is about shoulder height
• Pain when lying on the sore shoulder or lifting with a straight arm
• Shoulder pain or clicking when you move your hand behind your back or head
• Shoulder and upper arm pain (potentially as far as your elbow)
How is it diagnosed?
A physiotherapist or sports doctor will diagnose shoulder tendonitis based on your symptom history and some clinical tests. An ultrasound scan is the preferred method of investigating a shoulder tendonitis because X-rays do not identify shoulder tendonitis.
What is the prognosis?
Shoulder tendonitis is a progressive disorder that often co-exists with bursitis or bicipital tendonitis. It can deteriorate into calcific tendonitis or rotator cuff tears, which may require surgery, with neglect or poor treatment. The good news is that most shoulder tendonitis is reversible and very successfully treated.
Due to shoulder impingement being the primary cause of your shoulder tendonitis, it’s vital to thoroughly assess and correct your shoulder biomechanics to prevent future shoulder impingement episodes and subsequent rotator cuff tendonitis.
Visit a physiotherapist who can give you an assessment and shoulder exercises for biomechanical correction. The physiotherapists at CBD Physio can help to diagnose and treat specific shoulder injuries.
Shoulder Tendonitis Treatment
Researchers have concluded that there are seven stages that need to be covered to effectively rehabilitate shoulder tendonitis and prevent recurrence. These are:
Phase 1 – Early Injury Protection: Pain Relief & Anti-inflammatory Tips
As with most soft tissue injuries, the initial treatment is rest, ice, and support.
In this early phase, you’ll most likely be unable to fully lift your arm or sleep comfortably. Our first aim is to provide you with some active rest from pain-provoking postures and movements. This means you should stop doing the movement or activity that provoked the shoulder pain in the first place and avoid doing anything that causes pain in your shoulder.
Ice is a simple and effective at reducing your pain and swelling. You should apply for 20-30 minutes each 2 to 4 hours during the initial phase.
Anti-inflammatory medication (only if recommended by your GP) and natural substances such as arnica might also help to reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.
To support and protect your tendon injury, you may need to wear a sling to provide pain relief. You might need to sleep upright or with pillow support, depending on the nature and the extent of your injury.Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations, massage, acupuncture or dry needling to assist you during this pain-full phase.
Phase 2: Regain Full Range of Motion
If shoulder injuries are treated properly, the injured tissues will heal. Inflamed structures e.g. (tendonitis, bursitis) will settle when they’re protected from additional damage. Shoulder tendonitis takes time to heal – scar tissue needs to be formed and matured – and this takes at least six weeks. During this time, it is important to lengthen and orientate your healing scar tissue via joint mobilisations, massage, muscle stretches, and light active-assisted and active exercises. Researchers have concluded that physiotherapist-assisted joint mobilisations will improve your range of motion quicker and, in the long-term, improve your functional outcome.
Signs you have full soft tissue extensibility includes being able to move your shoulder through a full range of motion. In the early stage, this may need to be done by someone else, such as your physiotherapist. As you improve, you’ll be able to do this under your own muscle power.
Phase 3: Restore Scapular Control
Your shoulder blade (scapula) is the base of your shoulder and arm movements. Your shoulder blade has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.
Normal shoulder blade shoulder movement – known as scapulohumeral rhythm – is required for a pain-free and powerful shoulder function. Researchers have identified poor scapula-humeral rhythm as a major cause of rotator cuff impingement. Any deficiencies will be an important component of your rehabilitation.
Your physiotherapist can assess and correct your scapulohumeral rhythm. They’ll be able to help you correct your normal shoulder motion and provide you with scapular stabilisation exercises if necessary.
Phase 4: Restore Normal Neck-Scapula-Thoracic-Shoulder Function
Your neck and upper back (thoracic spine) are very important in the rehabilitation of shoulder pain and injury. Neck or spine dysfunction cannot only refer pain directly to your shoulder, but it can affect a nerve’s electrical energy supplying your muscles cause weakness. Painful spinal structures from poor posture or injury don’t provide your shoulder or scapular muscles with a solid pain-free base to act upon.
In most cases, especially chronic shoulders, some treatment directed at your neck or upper back will be required to ease your pain, improve your shoulder movement and stop pain or injury returning. Your physiotherapist will assess your neck and thoracic spine and provide you with the necessary treatment as required.
Phase 5: Restore Rotator Cuff Strength and Function
Your rotator cuff is the most critical group of shoulder control and stability muscles. Among other roles, your rotator cuff maintains “centralisation” of your shoulder joint. Your rotator cuff also provides the subtle glides and slides of your shoulder’s ball joint on the glenoid socket to allow full shoulder movement.
It may seem odd that you don’t attempt to restore the strength of your rotator cuff until a later stage in the rehabilitation. However, if a tendon structure is injured we need to provide nature with an opportunity to undertake primary healing before we load the structures with resistance exercises.
Having said that, it is important to strengthen the rotator cuff muscles in a successful shoulder tendonitis rehabilitation program. Your rotator cuff exercises need to be progressed in both load and position to accommodate for your specifically injured rotator cuff tendon(s) and whether or not you have a secondary condition such as bursitis. Your physiotherapist will prescribe the most appropriate rotator cuff strengthening and shoulder exercises for you.
Phase 6: Restore High Speed, Power, Proprioception & Agility
If your shoulder tendonitis has been caused by sport it is usually during high speed activities, which place enormous forces on your body, or repetitive actions.
As you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance. Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepare you for light sport-specific training.
Phase 7: Return to Sport or Work
Depending on the demands of sport or your job, you will require specific sport-specific or work-specific exercises and a progressive training regime to enable a safe and injury-free return to your chosen sport or employment.
Sports that involve overhead arm positions such as racquet sports, throwing, bowling or swimming have high incidences of shoulder tendonitis. Your technique should ideally be assessed by your physiotherapist and/or sports coach.
Your chosen physiotherapist at CBD Physio will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport or work. Work-related injuries will often require a discussion between your doctor, rehabilitation counsellor or employer.
The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.
To speak to someone about your shoulder injuries, or to ask advice about the best shoulder exercises for treatment, make an appointment with a physiotherapist at CBD Physio. Our physiotherapists are experienced and always want to give you the best treatment possible.
Call us on 02 9223 3122.
By Ashton Lucas
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