The shoulder joint, known for its extensive range of motion, relies on muscles, ligaments, and tendons for movement and stability. Tendons are robust fibrous cords that link muscles to bones, transmitting force for movement. When these tendons experience chronic issues, conditions like tendinosis can develop, affecting shoulder function. This condition represents a persistent problem within the tendon, distinct from an acute injury.
Understanding Shoulder Tendinosis
Shoulder tendinosis involves a breakdown of collagen fibers within a tendon, not an active inflammatory process. This degeneration typically arises from repeated micro-traumas that exceed the tendon’s repair capacity. Unlike tendinitis, which involves acute inflammation, tendinosis reflects a chronic degenerative state where the tendon’s structure disorganizes. The rotator cuff tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) are frequently affected due to their central role in arm movement and stability. This leads to a weakened tendon structure, less resilient to stress.
Common Causes
Shoulder tendinosis often develops from repetitive motions that strain shoulder tendons. Occupations or activities requiring overhead arm movements, such as painting, swimming, or throwing, can gradually lead to micro-tears and degeneration.
Poor posture also contributes by altering shoulder biomechanics, placing undue stress on tendons. Slouching or rounded shoulders can compress the subacromial space, where rotator cuff tendons pass, leading to impingement and wear.
Age-related changes in tendon elasticity and repair capacity also make individuals more susceptible, as tendons naturally become less resilient. Inadequate warm-up or cool-down periods can leave tendons unprepared for exertion or hinder recovery, accelerating degeneration.
Recognizing Symptoms
Individuals with shoulder tendinosis often report a persistent, dull ache deep within the shoulder, intensifying with specific movements or activities. This pain typically worsens when raising the arm overhead or lifting.
Stiffness in the shoulder joint is common, particularly in the morning or after inactivity. The affected area may also feel tender to the touch, especially along the involved tendon. Pain and stiffness can significantly restrict shoulder range of motion, making everyday tasks challenging. Activities like reaching behind the back, sleeping on the affected side, or dressing can become difficult. These symptoms can impact participation in sports, occupational duties, and daily activities.
Diagnosis and Treatment
Diagnosing shoulder tendinosis begins with a physical examination, where a healthcare provider assesses range of motion, strength, and tenderness. Medical history, including occupational activities, sports participation, and symptom onset, provides important context.
Imaging tests confirm the diagnosis and rule out other conditions. X-rays can identify bone spurs or bony abnormalities that might contribute to tendon irritation, though they do not visualize soft tissues. MRI or ultrasound scans offer detailed views of soft tissues, visualizing tendon degeneration, tears, or thickening.
Treatment
Treatment for shoulder tendinosis primarily focuses on non-surgical approaches to reduce pain, improve function, and promote tendon healing. Rest and activity modification are initial steps, involving temporary cessation or reduction of aggravating activities.
Physical therapy is a cornerstone of treatment, emphasizing exercises to strengthen rotator cuff muscles and improve shoulder mechanics. Eccentric exercises, which involve lengthening a muscle under tension, are beneficial as they stimulate collagen production and reorganize tendon fibers, improving tendon strength and resilience.
Pain management often includes over-the-counter pain relievers or NSAIDs, though their effectiveness for tendinosis is limited due to its non-inflammatory nature. Corticosteroid injections may provide short-term pain relief by reducing local inflammation, but are used cautiously as repeated injections can weaken the tendon. Platelet-Rich Plasma (PRP) injections, using a concentration of a patient’s own platelets, promote tissue repair and regeneration. Surgery is a last resort, typically reserved for severe cases where non-surgical treatments have failed after 6 to 12 months, or if there is a significant tendon tear.
Preventive Measures
Preventing shoulder tendinosis involves practices that reduce stress on tendons and promote their health. Maintaining proper posture, especially during prolonged sitting or repetitive tasks, helps align the shoulder joint correctly, reducing strain on the rotator cuff.
Regular stretching improves flexibility in the shoulder and surrounding muscles, preventing tightness that can contribute to tendon impingement. Strengthening exercises for the rotator cuff and scapular stabilizer muscles are also important, as robust muscles provide better support and stability.
Using proper form during physical activities and sports minimizes improper loading on tendons. Learning correct techniques for lifting, throwing, or overhead movements reduces the risk of micro-trauma.
Taking regular breaks during repetitive tasks allows tendons to recover and prevents cumulative stress. Gradually increasing the intensity and duration of physical activity gives tendons time to adapt and strengthen, reducing overload and degeneration.