Shoulder Tendonitis: Understanding the Causes and Best Treatment Approaches

Shoulder tendonitis is the inflammation of one or more tendons that connect the biceps and muscles of the rotator cuff with the skeletal frame. A wide range of arm movements, including linear and rotational, depends on the strength and integrity of the shoulder joint and the muscles supporting it. 

Shoulder tendonitis, regardless of its causes, restricts the range of motion due to the pain experienced in attempts to mobilize shoulder joints. Thus, it affects basic daily activities, such as holding a glass of water using a hand. It also disrupts long sleep during the night. 

The possible reason is decreased blood flow as the position of muscles and tendons change due to gravity, worsening the pain.

Causes of Shoulder Tendonitis

Physical activities that apply abnormally high-stress levels are the major shoulder tendonitis causes, leading to inflammation and irritation. 

Anatomy of the Shoulder

The shoulder is an articulation among the upper limb, shoulder plate, and axial skeleton. Three bony structures that form the frame of the shoulder are the humerus (upper arm bone), clavicle (collarbone or beauty bone), and scapula (shoulder plate. It consists of four joints as follows. 

  • The sternoclavicular joint connects the clavicle with the uppermost segment of the sternum, establishing the link between the upper arm and axial skeleton. 
  • The acromioclavicular joint connects the collarbone with the outermost tip of the shoulder plate.
  • The scapulothoracic joint is a pseudo joint that connects the anterior surface of the medial border of the scapula with the convex surface of the posterior rib cage. 
  • The glenohumeral joint is a ball-and-socket joint wherein the glenoid fossa of the scapula accommodates about one-third of the humeral head. 

The intrinsic muscles of the shoulder support and stabilize the joints connecting the scapula and clavicle with the humerus. Concerning shoulder tendonitis, two muscle groups are relevant. 

  • Rotator Cuff

It is an assembly of four muscles and tendons. Supraspinatus, infraspinatus, teres minor, and subscapularis are the components of the joints. They cover the glenohumeral head and provide support and stabilise the joint. 

  • Biceps Brachii

It is a large muscle that spans along the humerus on the ventral surface. It has two components, a short and a long head. The short head attaches to the coracoid process, while the tendon of the long head connects with the glenoid and extends into the intertubercular groove in the humerus. 

Shoulder tendonitis occurs due to inflammation of any of these tendons disrupting the anatomical integrity of the shoulder. 

Symptoms of Shoulder Tendonitis

  • Common Symptoms

Primarily, any damage or injury to the shoulder restricts the freedom of movement of the affected arm. The common symptoms of shoulder tendonitis are as follows.

  • Pain or soreness in the shoulder
  • Inability to move the arm and hold it in a position involving the shoulder
  • Shoulder pain during the night
  • When to See a Doctor

Patients must consult a doctor for the following conditions.

  • Unbearable pain
  • Zero shoulders or arm mobility
  • Persistent disrupted sleep due to shoulder pain
  • Numbness or tingling sensations in the arm or hand of the affected shoulder
  • Possible Complications

Complications associated with shoulder tendonitis are as follows.

  • Persistent pain
  • Recurrent symptoms
  • Disruption of the sleep cycle due to pain
  • Chronic or atrophic tears pose a high risk of degenerative joint disease and rotator-cuff arthropathy.

Treatment Approaches for Shoulder Tendonitis

Doctors classify patients into one of three groups based on the complex nature of the disease. 

  • Group 1

Patients do not present with symptoms, but the MRI scans show partial or full-thickness tears of tendons. Non-operative modalities are effective for these patients. 

  • Group 2

Patients experience symptoms with evidence of partial thickness tear. Treatment begins with non-operative methods. Based on the response, doctors may suggest surgical intervention between 3 to 18 months from the disease onset.

  • Group 3

Patients suffer from long-lasting symptoms due to chronic rotator cuff tears. Treatment recommendations for this group are still tentative due to a lack of data on the effectiveness of rotator cuff repair compared to continued non-operative modalities. 

Conservative Treatment Options

  • Rest and Activity Modification

Rest and partial abstinence from high-intensity physical activities prevent the condition from exacerbating. Upon restoration of movement, modifications in the mechanics of shoulder movement help prevent a recurrence of this condition.

  • Physical Therapy

It is the first-line shoulder tendonitis treatment. Patients with partial thickness tears can manage with physical therapy alone. The standard program involves 

  • Resistance exercises to strengthen the rotator cuff and periscapular stabilizer
  • Stretching exercises to restore the range of motion of the shoulder
  • Pain Management

Though the evidence is inconclusive, non-steroidal anti-inflammatory drugs remain the first-line medication for shoulder tendonitis. Cortisone injections help in acute pain.  

Invasive Treatment Options

  • Injection Therapy

It involves injecting cortisone into the subacromial space for instantaneous pain relief. Ideally, it is used to help patients participate in physical therapy effectively. 

  • Surgery

Surgical interventions are either open surgery or arthroscopy. Open surgery involves exposing the affected area through a wide cut in front of the shoulder, while arthroscopy involves accessing affected tissues using tube-like instruments inserted through small incisions. 

The rationale behind surgical treatment for shoulder tendonitis is the removal of inflamed tissues and repairing damaged tendons. 

Home Remedies for Shoulder Tendonitis

Home remedies help improve shoulder pain and slow down the worsening of tendonitis. Some home remedies are as follows.

  • Compression using an ACE bandage helps reduce pain.
  • Heat therapy helps reduce tension in the muscles and reduces stiffness.
  • Over-the-counter medications, such as diclofenac, provide temporary relief from pain.  

Conclusion

Shoulder tendonitis primarily occurs due to overuse or repetitive movement of the shoulder awkwardly. It affects the quality of life as it restricts the range of motion of arms and renders patients dependent on another person as the condition worsens. Thus, early diagnosis prevents the progression of the tendon tear and further complications. 

While physical therapy and NSAIDs are effective in the initial stages of inflammation, severe cases require surgical interventions. Arthroplasty is the most non-invasive treatment for shoulder tendonitis that excises inflamed tissue and repairs the tendons. Individuals at risk of shoulder tendonitis must reduce the stress on the joint and modify the mechanics of their arm movements.

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