by Cameron Hatrick
Because we use our arms continuously throughout the day, shoulder pain is something that is near impossible to ignore. One of the common causes of such pain is tendonitis, as Consultant Orthopaedic Surgeon Cameron Hatrick explains.
WHAT IS TENDONITIS?
The term ‘tendonitis’ means inflammation of a tendon, usually as the result of an injury or a period of overuse. ‘Tendinosis’ means chronic degeneration of a tendon, usually as the result of repeated minor injuries failing to heal properly. Tendons are strong cords of tissue that attach muscle to bone and they help to move the joints when the muscles contract. In the shoulder the four main tendons attaching to the head of the humerus (the arm bone) are collectively known as the rotator cuff. They are covered with a bursa which helps the tendons to glide beneath the overlying acromion bone. This is why, in the shoulder, rotator cuff tendonitis is also known as subacromial bursitis. As the pain is caused by ‘pinching’ of the inflamed bursa and tendon beneath the acromion it may also be called ‘impingement’. (Repeated episodes of tendonitis may lead to chronic damage and tendinosis or even tearing of the degenerate tendon.)
WHAT CAUSES TENDONITIS?
Tendonitis typically occurs after an injury to the shoulder, such as a fall, or after a period of overuse such as taking up tennis or returning to the gym after a break. The rotator cuff tendons suffer a minor injury and become inflamed, as does the overlying bursa. The swollen tissue is compressed beneath the acromion bone causing pain.
HOW DO I KNOW IF I HAVE TENDONITIS?
The main symptom of shoulder tendonitis is pain, particularly when lifting the arm away from the side or when lying on it at night. Typically, you will have difficulty with activities such as putting on a jacket or removing a sweater. Some patients feel the pain when their arm is lifted a certain height and it reduces again when the arm is fully elevated. This is known as a ‘painful arc’.
HOW DO I TREAT TENDONITIS?
Rest and activity modification are the first line of treatment. Avoid the activity which caused the pain and try to avoid those which trigger the pain, although this is not so easy when it’s your shoulder! Taking painkillers like paracetamol or ibuprofen also helps, as well as applying an ice pack or a bag of frozen peas to the affected area. Appropriate stretching and strengthening exercises will allow the inflammation to settle whilst maintaining the strength of the rotator cuff. Treatments such as physiotherapy or, occasionally, a steroid injection can be used to treat more persistent cases of tendonitis. Surgery is usually only recommended, after several months, if nothing else has worked.
Warming up correctly before regular sports or exercise will make your body ready for more vigorous activity, and also help to avoid injury. Cooling down and stretching after you finish will also help. If tendonitis is something you have suffered with in the past as a result of exercising or playing sport, you may be able to prevent it from recurring by using different equipment or asking the opinion of a coach about changing your technique.