What is Shoulder Tendonitis?
Shoulder tendonitis refers to inflammation of the tendons in the shoulder joint. Tendons are fibrous cords that attach muscles to bones, and they can become irritated or inflamed from overuse, leading to injuries.
The most commonly affected tendon in the shoulder is the rotator cuff tendon. The rotator cuff comprises four muscles and tendons that stabilize the shoulder joint and allow overhead arm movements. Repeated small tears or wear and tear to the rotator cuff tendons from overuse can lead to tendonitis.
Activities requiring frequent overhead reaching and lifting are common culprits for rotator cuff tendonitis. Sports like baseball, tennis, swimming, weightlifting, and activities like painting, stocking shelves, or lifting overhead are associated with cuff tears and tendonitis. Tendonitis can happen suddenly from injury, or develop gradually from repetitive strain.
What is the difference between a rotator cuff tear and tendonitis?
While they affect the same set of tendons in the shoulder, a rotator cuff tear and tendonitis have some key differences:
- Tendonitis refers to inflammation and irritation of the rotator cuff tendons. A rotator cuff tear means a tendon has suffered a partial or complete rupture.
- Tendonitis usually comes on gradually from overuse. A tear can happen suddenly from trauma or a bad fall, though tears can also result from degeneration over time.
- Tendonitis may heal with rest. Tears, especially full-thickness tears, often require surgery to repair the damaged tendon.
- Tendonitis causes localized shoulder pain made worse with movement. Tears can cause shoulder weakness, decreased range of motion, and pain at rest.
- With tendonitis, inflammation is visible on imaging like ultrasound or MRI. Tears can be diagnosed from imaging or physical exams testing shoulder strength.
While advanced cases of tendonitis can weaken tendons and make them prone to tearing, inflammation, and tears have different root causes, severity, and treatments.
What causes a rotator cuff injury, tear, or tendonitis?
There are several factors that can contribute to problematic rotator cuff inflammation or tears:
- Repetitive strain: Repeated overhead motions, especially forceful exertions, fatigue the cuff tendons over time. Sports, physically demanding jobs, and activities involving lifting overhead are high risk.
- Age: As we age, tendons lose elasticity and become weaker. Tears become more common over the age of 40.
- Acute injury: Falls or sudden impacts like a car accident can tear a previously healthy cuff. Forceful lifting or pulling can also tear tendons.
- Anatomical issues: Shoulder instability, irregular shoulder socket shape, or bony spurs rubbing on tendons increase injury risks.
- Muscle imbalance: Weak or imbalanced shoulder muscles lead to overcompensation and strain on the rotator cuff tendons.
A combination of factors like aging, overuse, and anatomical structure often contributes too. Activities, occupations, and acute injuries add stress that can inflame or tear vulnerable tendons.
What are the symptoms of a rotator cuff tear or tendonitis?
Some common signs of rotator cuff tendonitis or tears include:
- Pain with overhead motion or exertion – Lifting the arm over the head, reaching behind the back, or forceful pushing/pulling can hurt
- Night pain – Tendonitis and tear pain often disrupt sleep, especially lying on the affected side
- Stiffness, loss of range of motion – Inflammation and tears restrict shoulder motion
- Clicking, catching, or grinding – Audible or palpable shoulder popping may indicate a tendon injury
- Weakness – Advanced tears cause decreased shoulder strength and function
- Swelling, redness (tendonitis) – Inflamed tendons may visibly swell or redden
- Bruising, deformity, “drooping” – Signs a tear has substantially damaged the rotator cuff
How is a shoulder injury diagnosed?
Doctors use a combination of exams and imaging to properly diagnose the cause of shoulder pain and dysfunction. They will ask about symptoms, perform a range of motion tests, and check for weakness and signs of injury. Tests like the “empty can” and “full can” assess specific muscles and movements. X-rays can detect bone deformities or arthritis. An MRI provides the most definitive images of soft tissue injuries like rotator cuff tears. Ultrasound also visualizes the cuff tendons and areas of inflammation. These imaging and physical exam findings help determine whether tendonitis, partial or complete tears, or other shoulder problems are responsible for the symptoms.
What is the treatment for rotator cuff tears, tendonitis, and other shoulder injuries?
Treating shoulder injuries varies depending on the exact diagnosis:
- Tendonitis is usually managed with rest, ice to reduce inflammation, NSAID medications, and physical therapy to strengthen the shoulder and improve mobility. Cortisone injections can also calm inflammation.
- Partial tears may heal with conservative treatment like immobilization followed by PT. Surgery may be considered if pain and dysfunction persist.
- Full-thickness tears almost always require surgery to suture the separated tendon ends back together. Post-surgical rehabilitation is crucial.
- Osteoarthritis is treated with NSAIDs, cortisone injections, physical therapy, and surgery if joint damage is severe.
Getting an accurate diagnosis guides the appropriate treatment plan. Minor tears and tendonitis often improve with non-surgical methods, while major rotator cuff tears and bone injuries frequently require surgical repair and extended recovery times.
In summary, watch for increasing shoulder pain, stiffness, reduced movement, weakness, and impairment of daily activities. See a doctor if symptoms persist over 2 weeks to assess the severity and recommend proper treatment. Rest, medication, physical therapy, or surgery may be warranted depending on the diagnosis.
