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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 and impingement.

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 tendons.
    • 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 injury completely.
    • 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 night.

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.

Diagnosing 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.

Tendonitis Surgery

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 the acromion.
  • Remove chronically inflamed, thickened and fibrotic bursal tissue.
  • 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.

Preparation

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Refrain from eating or drinking anything after midnight the night before surgery.


 

   

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