Shoulder Injuries: Tendinitis
Shoulder tendinitis is a common overuse injury in sports such as swimming, baseball (during the throwing motion), and tennis (during the overhead motion). The pain—usually felt at the tip of the shoulder and referred or radiated down the arm—occurs when the arm is lifted overhead or twisted.
In extreme cases, pain will be present all of the time and it may even wake you from sleep.
The shoulder is a ball and socket joint. The humerus (upper arm bone), the tendons of the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor) which connect the humerus to the muscles that lift the arm, and associated bursa (friction-reducing membranes), move back and forth through a very tight archway of bone and ligament called the coracoacromial arch. When the arm is raised, the archway becomes compressed against the tendons and bursa. Repetitive use of the arm causes the tendons and bursa to become frayed resulting in inflammation.
Bursitis occurs when the bursa becomes inflamed and painful due to compression inside of the coracoacromial arch.
Tendinitis occurs when a rotator cuff tendon becomes irritated, inflamed or partially torn. Symptoms of tendinitis and bursitis usually last for only a few days, but may recur or become chronic.
STAGES OF TENDINITIS
Overuse tendinitis. Shoulder motions used during activities like golfing, throwing or overhead lifting may cause repetitive stress within the rotator cuff, leading to irritation, bruising or fraying of the tendon. This can cause shoulder pain and weakness in the joint.
Calcific tendinitis. Inflammation over a long period of time can sometimes result in a build-up of calcium deposits within the rotator cuff tendons. This leads to pain and loss of shoulder strength and motion.
Rotator cuff tear. Severe tendinitis from fraying or degeneration, or from a sudden injury like (such as a fall) can cause partial or complete tearing of the rotator cuff tendon(s). This can result in more severe shoulder pain, weakness, loss of normal movement, and awakening at night due to pain.
- Overuse – Repetitive overhead motion is the most common cause of rotator cuff degeneration.
- Weak muscles – When the rotator cuff muscles are weak, more force is exerted on the tendons and bursa by the action of the deltoid muscle.
- Improper/ inappropriate swimming or throwing techniques.
- Strenuous training – One hard throw, weight lift or workout may start the problem.
- Previous injury to the shoulder.
- Loose shoulder joint.
Rest. Avoid activities that cause pain, especially if the pain is worse the next day. Avoid the activity that started the problem. Do not use the arm repeatedly out to the side of the body.
Ice. Apply an ice bag (over a towel) to your shoulder at least twice a day for 20 minutes. Also apply ice after any activity that aggravates your shoulder pain.
Medication. An anti-inflammatory/pain medication (such as Advil, Eleve or aspirin) relieves pain and inflammation. An injection of cortisone with lidocaine into the shoulder bursa may be recommended. If you receive an injection, do not use the shoulder for vigorous activities for about two weeks.
Physical therapy. Your surgeon may send you to a physical therapist for exercises or for other therapy. Exercises to strengthen the shoulder may help to prevent a recurrence.
Surgery. Surgery may be required to treat shoulder tendinitis and bursitis if it becomes chronic or if there is a tear of the rotator cuff.
RETURNING TO SPORTS
General Principals. Rest the shoulder until your symptoms clear. When you go back to your sport, go back slowly. Warm up well and do flexibility exercises before starting. Avoid the overhead position and do not play excessively long. Gradually increase the intensity of your activity.
Throwing sports. Initially, an underhand or side arm throw will be easier than an overhand throw. Warm-up well. Throw easily and gradually increase to harder throwing. Try to maintain a smooth throwing motion that will make use of the overall strength of your body.
Swimming. Breaststroke or sidestroke will be easier than crawl or butterfly strokes. Sometimes the back-stoke is permitted. Be sure that your swimming mechanics and style are correct.
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