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Shoulder tendonitis

Tendons are contractile tissues that connect muscle to bone. Tendonitis is simply an inflammation of that tissue. The most common tendons in the shoulder that are affected are the four rotator cuff tendons and the biceps tendon.

CAUSES: Tendonitis is often due to performing a repetitive motion such as throwing a ball or doing repetitive work with your hands. Tendonitis may also stem from degeneration of the tissue over time causing more wear and tear leading to injury. Impingement of a tendon by surrounding structures may cause tendonitis due to the rubbing of that structure against the tendon causing inflammation.

SIGNS/SYMPTOMS: Pain is the main presentation of tendonitis of the shoulder. Biceps tendonitis usually presents with pain in the front or side of the shoulder and may travel to the elbow. Any action that contracts the bicep muscle tends to cause an increase in pain. Rotator cuff tendonitis usually causes pain at the tip of the shoulder and/or the upper part of the outside of the arm. Various motions such as lifting, overhead activity, pushing, and pulling can increase pain.

DIAGNOSIS: The history of pain and physical exam can tell a lot about shoulder problems. Palpation and muscle testing can help to localize the tendon(s) involved. X-rays are usually not too helpful since tendons are not visualized with x-ray. An MRI can show the extent of injury to the tendon.

TREATMENT: Any kind of anti-inflammatory and pain reliever, whether it is natural or synthetic, can help. Avoid repetitive motions, particularly ones that cause pain. Chiropractic adjustments may be beneficial depending on if there are any misalignments leading to irritation. Rehabilitative exercises are important eventually to prevent muscle atrophy and improve strength. Special care should be taken to avoid aggravating activities. Low level laser therapy (LLLT) may afford relief by decreasing inflammation and pain. Steroid injections are also an option if more conservative care yields few results. There are risks with those injections, however, so do your research. If there is tearing of the tendon, surgery may be required to repair the tear.

COMPLICATIONS: Tendonitis of the shoulder, if not dealt with properly, may lead to frozen shoulder syndrome (adhesive capsulitis) which causes stiffness and increased pain.

PROGNOSIS: The outcome with conservative care is usually good if the modifications and recommendations are performed. Non-surgical recovery can take anywhere from weeks to months depending on the severity and the compliance with treatment. Usually it is a gradual improvement over time versus a sudden decrease in pain and increase in function.