Tendonitis of the Shoulder
What is tendonitis?
Tendinitis is inflammation (redness, soreness, and
swelling) of a tendon. In tendinitis of the shoulder the
tendons of the rotator cuff or the tendons of the biceps
become inflamed and irritated. This is often a result of
being pinched by surrounding structures. This injury can be
mild or severe. When the rotator cuff tendon becomes
inflamed and thickened, it may get trapped under the
acromion (the top of the shoulder blade). This squeezing of
the rotator cuff muscles is called impingement syndrome.
Tendinitis and impingement syndrome are often accompanied
by inflammation of the bursa sacs that protect the shoulder.
An inflamed bursa is called bursitis. Sports involving
overuse of the shoulder and occupations requiring frequent
overhead reaching are other potential causes of irritation
to the rotator cuff or bursa and may lead to inflammation
What causes tendonitis?
- Repetitive strain on the tendon
Repetitive strain is by far the most common cause of
tendonitis. Repetitive strain can some in many forms and
from many sources. Tendonitis of the elbow, bicep,
shoulder and hand is often developed by individuals that
work on factory production lines due to the repetitive
nature of the work involved. Sports professionals (like
golfers and tennis players) often develop tendonitis
from the repetitive movements in their sports.
• Age related tendon changes
As the human body gets older the tendons get harder
and lose their elasticity. This means that the joint is
no longer as free to move and often flexibility is lost.
As individuals get older they are much more prone to
develop tendonitis. The cause of tendonitis from age is
still not fully understood. It's suggested that as the
body ages the change in blood vessels effects the
• Putting the tendon under too much strain
This is the leading cause of tendonitis amongst
strength athletes and bodybuilders. Tendonitis is
developed when the individual puts the tendon under too
much strain without properly warming up or under strain
that the tendon simply cannot handle. This tendonitis
cause can easily be avoided by using correct training
techniques and exercise form.
• As a result of injury
It is not uncommon for tendonitis to develop as a
result of another tendon or joint injury. For example,
shoulder tendonitis is often developed after a rotator
cuff injury and knee tendonitis can be developed after
having knee surgery. In these cases tendonitis usually
develops because the injury has not completely healed.
This cause of tendonitis can easily be avoided by
getting sufficient rest for the joint to recover from an
• As a result of another condition
In some cases diseases like rheumatoid arthritis or
diabetes may cause tendonitis to occur. These cases are
often rare and only occur when the individual puts the
tendon under an unusual amount of pressure or strain.
• Thermal injury to the tendon
Thermal injury is generall a very uncommon cause of
tendonitis. Thermal injury is often experienced by
outdoor mountain climbers, rock climbers and hikers. In
most cases the affected areas are the hands, wrists,
ankles and feet.
• Anatomical cause of tendonitis
Anatomy is a rare cause of tendonitis. If the tendon
does not have a smooth surface area in which to work
against it will often become inflamed and irritated
quite easily. In these situations surgery is often
required to rectify the problem.
What are the symptoms of tendonitis?
Early signs of shoulder tendonitis include a slight pain
in the shoulder/upper bicep area when you move your arm up
and down. This pain may only occur when the shoulder is
under pressure but may still occur at anytime of the day or
As the tendonitis develops the pain will get more severe
and spread from the area where the shoulder meets the arm to
all over the rotator cuff. The shoulder will often feel
tender and in more severe cases some swelling may be
experienced. It's always best to consult your GP to
correctly diagnose shoulder tendonitis.
Tendinitis is almost always diagnosed on physical
examination. Findings consistent with tendinitis include:
- Tenderness directly over the tendon
- Pain with movement of muscles and tendons
- Swelling of the tendon
Are X-rays or MRIs needed to diagnose tendinitis?
Studies such as x-rays and MRIs are not usually needed to
make the diagnosis of tendinitis. While they are not needed
for diagnosis of tendinitis, x-rays may be performed to
ensure there is no other problem, such as a fracture, that
could be causing the symptoms of pain and swelling. X-rays
may show evidence of swelling around the tendon.
MRIs are also good tests identify swelling, and will show
evidence of tendinitis. However, these tests are not usually
needed to confirm the diagnosis; MRIs are usually only
performed if there is a suspicion of another problem.
If symptoms persist, surgery to remove a spur on the
acromion can increase the space available for the inflamed
tendon and may prevent further fraying or complete rupture.
If an MRI shows a complete muscle injury, surgical repair
may be required.
Surgery for recurrent rotator cuff tendonitis (bursitis)
is occasionally performed to:
- Remove a prominence or spur on the undersurface of
- Remove chronically inflamed, thickened and fibrotic
- Inspect the tendons and tidy up and sometimes repair
a tear in the tendons.
These procedures are often done in combination. This can
be done either through an open or an arthroscopic approach
with the start of an early rehabilitation program one or two
days after surgery and advancing to a more comprehensive
program between two and five weeks after surgery. The
initiation and progression of these exercises is dependent
upon the patient’s findings at surgery, surgical procedure
and rate of healing.
- Complete any pre-operative tests or lab work
prescribed by your doctor.
- Arrange to have someone drive you home from the
- Refrain from taking aspirin and non-steroidal
anti-inflammatory medications (NSAIDs) one week prior to
- Refrain from eating or drinking anything after
midnight the night before surgery.