Shoulder Tendonitis - Center For Sports Medicine & Orthopaedics

Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service

Shoulder Tendonitis

Brett Sanders,
MD
Center For Sports Medicine and Orthopaedic
2415 McCallie Ave.
Chattanooga, TN
(423) 624-2696


Shoulder tendinitis is a common overuse injury in sports
(such as swimming, baseball and tennis) where the arm is
used in an 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 a deep sleep.

The shoulder is a closely fitted joint. The humerus
(upper arm bone), the tendons of the rotator cuff that
connect 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 smaller and compresses the
tendons and bursa. Repetitive use of the arm makes the
tendons and bursa prone to injury and 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 inflamed, swollen and tender.
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. • Impingement tendinitis. When the space is narrowed between the rotator cuff and the
coracoacromial arch, the humerus can "pinch" the rotator cuff tendon into the arch. This can happen
when the cuff is weak, the bursa is swollen or if there is a bone spur present. Tendinitis caused by
impingement can occur with repetitive shoulder activities, such as sports or jobs involving overhead
reaching. • Rotator cuff tear. Severe tendinitis from long term impingement, degeneration, or sudden injuries
like falling can cause partial or complete tearing of the rotator cuff tendon(s). This can result in more
severe shoulder pain, weakness and loss of normal movement and function.



Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service

Contributing Factors

• Overuse. Repetitive overhead motions are the most common cause of the problem.
• Weak muscles. When the muscles are weak, more force is exerted on the tendons and bursa, causing
inflammation and pain.
• Improper/ inappropriate swimming or throwing techniques.
• Strenuous training. One hard throw, weight lift or workout may start the problem.
• Previous injuries to the shoulder.
• Loose shoulder joint

Treatment

• Rest. Avoid things that hurt or make the pain worse the next day. Avoid the activity that started the
problem. Your doctor may recommend a sling to immobilize the shoulder.
• 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. Your doctor may prescribe anti-inflammatory/analgesic medication (in tablet form) to
relieve pain and inflammation while your body's natural healing process goes on. An injection of
cortisone with novocaine into the shoulder may be recommended. After receiving an injection, do not
attempt any vigorous activities with your arm for at least two weeks.
• Physical therapy. Your doctor may send you to a physical therapist for exercises or 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. In severe cases, all sports using the arm should be avoided. 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 for a long time. 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. Breast stroke or side stroke will be easier than crawl or butterfly strokes. Sometimes the
back-stoke is alright. Be sure that your swimming mechanics and style are correct.


Exercises and Rehabilitation

Your doctor or physical therapist will instruct the appropriate stretching and strengthening exercises.
These exercises are illustrated on the following pages.



Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service

Stretching Exercises

The following stretching exercises can be done to help restore shoulder range of motion. Each stretch can
be done to the point of a comfortable feeling of stretch and should be done slowly to allow the muscles
and soft tissues time to lengthen. Hold each stretch for 15 to 20 seconds. When stretching, your goal is to
reach the maximum range of motion for you
. It is recommended that you warm-up well before stretching
. Generally, you should do some walking, cycling or jogging so that you break a sweat before you start
stretching.
Allow the first one or two repetitions to be warm-up reps, with very little pain. Gradually work into more
and more range of motion as you begin to feel more flexible. Mild pain while stretching sometimes
occurs, however it is not recommended that you "push through the pain". If you are patient, the arm will
become looser as it warms-up. Do 5 to 10 repetitions, 2 or 3 times a day

Pendulum exercise
Bend over at the waist and let the arm hang down passively.
Using your body to initiate movement, swing the arm gently
forward and backward and in a circular motion. Do this
pendulum exercise for several minutes, 3 to 5 times per day.
Use this exercise as a warm-up activity before stretching.

Supine passive arm elevation
Lie on your back. Hold a cane or stick in both
hands, gripping the stick with the hands about
18 inches apart. With the elbows straight and
assisting with the opposite arm, lift the
cane upward, with the injured arm holding on,
as if to bring the hands overhead. Slowly lower
the arm back to the bed. The good arm should
do as much of the lifting and lowering in this
exercise as needed to avoid pain.
.



Hands Behind the Head Stretch
Lie on your back. Place your hands behind your head as shown in
the top picture. Slowly lower the elbows to stretch the shoulder
toward the position shown in the bottom picture of figure one.
Hold this position for ten seconds, then return to the starting position.
Do ten repetitions, two times a day.




Supine cross-chest stretch
Lying on your back, hold the elbow of the injured
arm with your opposite hand. Gently stretch the
elbow toward the opposite shoulder.
Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service

Standing external rotation
Stand with the injured shoulder toward a door as illustrated. While
keeping the operated arm firmly against your side and the elbow at a
right (90 degree) angle, rotate your body away from the door to produce
outward rotation at the shoulder. Hold ten seconds. Do ten repetitions,
two times a day.






Behind-the-back internal rotation
Sitting in a chair or standing, place the hand
of the injured arm behind your back at the
waistline. Use your opposite hand to pull
on a towel , as illustrated, to help the other
hand higher toward the shoulder blade.





Strengthening Exercises

Theraband Strengthening for the shoulder

These resistance exercises should be done very slowly in both

directions. The goal is to achieve a maximum amount of
strengthening while listening to your end-point of pain.
Work within a pain free range of motion at all times
and do the exercises very slowly. The slower the motion, the
better the muscle contraction is throughout the range
of movement. Do all exercises 15 to 20 times each, one to two
times a day.

Theraband strengthening exercises are illustrated on a separate page.

Developed by Alex Petruska, DPT and the Massachusetts General Hospital Sports Medicine Service