Anatomy & Background
A tendon is a strong, fibrous tissue that is responsible for transferring force generated by the muscle to the bone producing movement at the joint. Inflammation of the muscle tendon is called “tendinitis” and may result in pain paired with restriction of movement.
Tendinitis of the shoulder typically occurs in the subacromial space and is common due to the anatomy of the shoulder, coupled with stressful activity assigned to the joint. The subacromial space is an area on the top the shoulder formed by the coracoacromial arch. This arch is formed by the acromio-clavicular joint, coraco-acromial ligament and acromion (outer edge of the shoulder blade).
The chief tendons of the shoulder, the rotator cuff and long head of the biceps, pass under this arch. Reduction of this space exposes the tendons to a high risk for friction, rubbing and irritation, setting the stage for a case of tendinitis. Tendon problems usually emerge in individuals 40 to 60 years old, but are increasingly seen in young athletes as a byproduct of repetitive overuse.
What is Rotator Cuff Tendinitis?
The rotator cuff tendons stabilize the shoulder joint by attaching muscles originating at the shoulder blade to the head of the humerus (upper arm bone). There are four tendons in the rotator cuff that help control arm rotation and elevation: the supraspinatus, the subscapularis, the infraspinatus and the teres minor.
Damage to the rotator cuff is the most common cause of shoulder pain. The rotator cuff tendons are commonly irritated with repetitive overhead activities and routine lifting that may result in pain and weakness in the shoulder.
Tendinitis is most often diagnosed as an overuse repetitive strain injury (RSI), but most RSI cases exhibit genetically predisposed factors as well. Individuals that have a poor bloody supply to the area are most susceptible to inflammation and development of tendinitis (for example, the supraspinatous). Other high-risk activities or conditions that may lead to the development of shoulder tendinitis include:
- Participation in activities requiring overhead motions like swimming, tennis, softball and baseball.
- Repetitive strain injuries (RSI) at work are common in patients performing activities habitually, such as assembly line work.
- Sudden injury to the region like landing on the shoulder.
- Patients suffering from rheumatoid arthritis may have an increased risk to tendinitis.
- Aging, resulting in changes to tendon elasticity and circulation that increase the susceptibility to injury and reduce the ability to heal.
- Postural factors like leaning the head and shoulder forward, reducing the subacromial space, thus leading to irritation of the shoulder tendons
- Overload injuries derived from lifting heavy objects or weight training.
- Weakening of the rotator cuff, causing a muscular imbalance resulting in shoulder impingement (pinching).
Signs and Symptoms of Rotator Cuff Tendinitis
- Pain, either acute or dull, when preforming motions and pain that lingers even when the shoulder is at rest.
- In more severe cases, pain that radiates to the upper arm and is accompanied by a burning sensation restricting movement.
- Tenderness and/or tightness of the area, especially to one’s touch.
- Difficulty sleeping on affected side and pain that worsens overnight.
- Reduction of ability to preform tasks essential to daily life, such as difficulty dressing.
- Increased weakness and swelling of the tendon as inflammation escalates.
Treating and Managing Your Pain
At the first sign of tendinitis, one should avoid preforming positions and activities that increase and exasperate the pain stemming from the inflammation.
Conservative treatment plans exercised under a doctors care include rest, alternating application of heat and ice to the area, physical therapy and non-steroidal medications to reduce inflammation. A pain management program may be implemented to help limit discomfort allowing the patient to preform rehabilitation exercises.
If symptoms persist, steroidal medication or injections may be prescribed by your health care professional to be used in tandem with therapy. Surgical intervention may be discussed to treat highly severe cases to address and correct mechanical causes of the tendon irritation.
Physical Therapy Intervenes
If surgery is thought to be unnecessary, treatment plans will focus on the restoration of shoulder motion. As the pain dissipates, strengthening exercises should be initiated to prevent muscle weakness and atrophy. Common treatment methods of a Rotator Cuff Tendinitis includes:
- Manual Therapeutic Technique (MTT) including mobilization, soft tissue massage and manual stretching to regain motion range and flexibility of the shoulder.
- Therapeutic Exercises (TE) to regain range of motion and strengthen the shoulder and surrounding joints.
- Neuro-muscular re-education to begin retraining the upper extremities for use in daily activities.
- Scapular and shoulder stabilization exercises to improve stability of shoulder and support the acromioclavicular joint may also be initiated.
- Modalities including the use of ultrasound, electrical stimulation, icing the area and cold laser to decrease pain at the shoulder.
- Home exercise program that includes stretching and strengthening exercises.
If detected and treated early, many patients recover full function and range of the shoulder provided the patient is dedicated to the treatment program prescribed. Those patients dealing with a more involved situations such as impingement due to bone spurs, have high success rates with surgical decompression of the area. It is difficult to predict the outcome of tendon tears, as the success of rehabilitation is dependent on the size of the tear, integrity and elasticity of the tissue, patient age, preoperative condition of the patient and if the patient is experiencing any comorbid syndromes. Please refer to the Rotator Cuff Tear section for more information on tendon tears.
Preventing Rotator Cuff Tendinitis
Small measures can be taken by at-risk individuals to help prevent tendinitis. It is far easier to prevent the condition than it is to treat it, as some damage may be irreversible or costly to fix. Below are some tips to reduce the risk of tendinitis:
- Warm-up for athletic activity gradually. This improves circulation and lubrication to the muscle and tendon. Remember to stretch after preforming strenuous activity as well.
- Do not bounce when stretching. Instead, hold the stretch for 15 to 20 seconds.
- Utilize a strength-training program to improve and stabilize the muscles and tendons used for activity. A regular strength-training program three times a week will increase muscle health and help reduce weakening brought on by aging.
- Always listen to your body – do not work through pain. Avoid the “no pain, no gain” philosophy as you may inflict serious damage to yourself. Pain is the body’s way of notifying you to stop what you are doing.