The tendons connect muscle to bone and often near a joint.
Tendinopathy is an injury to the tendon. It causes pain, inflammation, and makes movement difficult. Tendinopathy may be: Tendinosis—tiny tears in the tendon with no significant inflammation (more common)Tendonitis—inflammation of the tendon (less common)
There are several tendons in the shoulder.
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Tendinopathy is most often caused by overuse of a muscle and tendon. Over time, the regular strain on the tendon causes the structure of the tendon to change.
tendons are overused most often with: Repeated reaching overheadRepeated throwing
Shoulder tendinopathy may also be caused by injury to the tendon from: Inflammatory disease in the shoulder, such as arthritisTrauma to the shoulder such as a fall on outstretched armsNormal wear and tear associated with age
Shoulder tendinopathy is more common in people 30 years and older. It is also common in people that regularly use the arm in an overhead position or throwing motion such as: Tennis or other racquet sportsSwimmingBaseballOverhead assembly work, butchering, or using an overhead pressing machine
Symptoms will develop gradually over time. Pain may not always be present but slowly increases with use.
Common signs of shoulder tendinopathy include: Pain (a dull ache) in the shoulder and upper armPain at night, especially when sleeping on the injured sidePain when trying to reach for a back zipper or pocketPain with overhead use of the armShoulder weakness, usually due to pain with effortShoulder stiffness with some loss of motion
You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor will check tender areas. Your shoulder range of motion, and muscle strength will also be checked. Most can be diagnosed based on your symptoms and physical exam.
If more damage is suspected or the diagnosis is unclear the doctor may order imaging tests. Tests may include MRI scan, x-rays, or CT arthrography.
Bursitis can cause similar pain symptoms. Your doctor may inject a medication that numbs pain. If the pain goes away, it may suggest bursitis not tendinopathy.
Tendinopathy may take weeks or months to fully heal. Treatments include:
Full rest is usually not needed. Tendons do need a break from activities that are causing pain. A gradual return to normal activity will decrease the chance of damaging the tendon again.
Medications may help to manage pain and inflammation. Options may include: Nonsteroidal anti-inflammatory drugs (NSAIDs)Topical pain medications that are applied to the skin
Persistent or severe pain may need steroid medication. The medication is injected directly to the area. These injections can not be done often because frequent use can damage the tendon.
Rehabilitation will help you regain strength and range of motion in your shoulder. It may also help to prevent future injuries. Rehabilitation may include: Physical therapy to strengthen muscles that control the shoulderExercises to maintain normal range of motionExercises for specific muscles that are used in sports or job activitiesGradual return to sports and workLearning how to adjust activities to prevent re-injury
Severe injuries may require surgery to repair the tendon. The type of surgery will depend on the specific injuries.
To help reduce your chance of shoulder tendinopathy: Do regular
resistance exercises to strengthen
the muscles.Use proper athletic training methods.Do not increase exercise duration or intensity more than 10% per week.Avoid overusing your arm in an overhead position.Alter job duties to avoid overhead activity.Do not ignore or try to work through shoulder pain.
Biceps tendonitis. Move Forward—American Physical Therapy Association website. Available at:
Updated December 19, 2013. Accessed September 16, 2015.
Bursitis and tendonitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
http://www.niams.nih.gov/Health_Info/Bursitis/default.asp. Updated June 2013. Accessed September 16, 2015.
Rotator cuff tendonitis. Move Forward—American Physical Therapy Association website. Available at: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=1bd18bbc-e7ea-436d-bc9e-ffee9c4dbd87#.VfG01UW6n-Y. Accessed September 16, 2015.
Swimmer's shoulder. Cleveland Clinic website. Available at:
http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-shoulder-tendonitis. Updated March 27, 2015. Accessed September 16, 2015.
Shoulder impingement/rotator cuff tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at:
http://orthoinfo.aaos.org/topic.cfm?topic=A00032. Updated February 2011. Accessed September 16, 2015.
Last reviewed September 2016 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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