Shoulder tendonitis, often referred to as tendinopathy, is a common source of shoulder pain that arises from irritation or inflammation of the tendons within the joint. This condition most frequently affects the rotator cuff tendons—the group of four muscles and their tendons that stabilize the shoulder—or the long head of the biceps tendon. The pain is typically caused by repetitive overhead motions or overuse, which can lead to friction and subsequent fraying of the tendon fibers. Treatment involves a methodical, stepped progression, beginning with the least invasive interventions and escalating only if symptoms persist. The goal is to reduce pain and restore full, pain-free function.
Initial Conservative Management and Medication
The initial approach to managing shoulder tendonitis focuses on immediate symptom relief and preventing further injury. This first step primarily involves relative rest, which means avoiding activities that cause pain, especially those involving repetitive overhead motions. Maintaining some movement is important to prevent the joint from becoming stiff, but activities like lifting heavy objects should be temporarily suspended.
Applying cold therapy, such as an ice pack, to the affected area for 15 to 20 minutes several times a day helps minimize both pain and inflammation. The cooling effect works by constricting blood vessels, which reduces local swelling and numbs the nerve endings in the shoulder. This simple measure is often effective for acute flare-ups.
Medication management starts with over-the-counter (OTC) Nonsteroidal Anti-inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, which work to decrease both pain and inflammation. Naproxen is often a preferred initial choice due to its longer duration of action, allowing for less frequent dosing. If OTC options do not provide sufficient relief, a physician may prescribe stronger NSAIDs or other pain relievers.
Prescription-strength NSAIDs, or sometimes a short course of oral corticosteroids, may be utilized for more severe inflammation. Muscle relaxers may be prescribed to help manage muscle spasms that can accompany the shoulder pain. The use of all anti-inflammatory medication should be limited to the shortest possible duration to mitigate potential side effects, particularly those affecting the gastrointestinal system.
Non-Invasive Physical Rehabilitation
Physical rehabilitation is considered the most reliable intervention for achieving long-term recovery and is often the best treatment for the majority of shoulder tendonitis cases. A structured physical therapy program is designed to move beyond pain relief and address the underlying biomechanical issues that caused the tendon irritation. The therapy systematically reintroduces controlled stress to the tendon, which is necessary for promoting structural healing and improving the tendon’s load tolerance.
The program typically begins with gentle range-of-motion exercises, such as pendulum swings, to maintain joint mobility without stressing the inflamed tendon. Once initial pain subsides, the therapist introduces specific strengthening exercises focused on the rotator cuff muscles and the scapular stabilizers. Strengthening the muscles that anchor the shoulder blade is important, as poor scapular control can lead to impingement and recurrent tendon irritation.
Exercises often involve resistance bands for external rotation and various wall slides to improve muscular endurance and coordination. A therapist also provides guidance on stretching to restore flexibility, including posterior shoulder stretches. This guided approach ensures that exercises are performed with correct form, preventing aggravation of the injury.
A crucial component of physical rehabilitation is patient education and activity modification advice provided by the therapist. This includes correcting poor posture, especially during desk work, and analyzing the mechanics of sports or work-related movements. By modifying the repetitive actions that led to the condition, physical therapy helps prevent future flare-ups and promotes long-term shoulder resilience.
Interventional and Surgical Options
When a patient’s condition fails to improve despite a dedicated course of conservative management and physical rehabilitation, the treatment path may escalate to interventional procedures. Corticosteroid injections are a common next step, delivering a potent anti-inflammatory agent directly into the subacromial space. These injections are highly effective for providing rapid, short-term pain relief, typically lasting a few weeks to months.
Corticosteroids do not offer a long-term cure, and multiple injections carry a risk of negative effects on tendon tissue, including potential weakening or structural disorganization. For this reason, physicians often limit the number of injections a patient receives. Platelet-Rich Plasma (PRP) therapy involves injecting a concentrated solution of the patient’s own platelets, rich in growth factors, into the injured area. PRP is theorized to promote healing and has shown promise in providing sustained pain relief for chronic rotator cuff tendinopathy, though its functional improvement benefits are still under review.
Surgical options are reserved as a last resort for cases of tendonitis that are refractory to all other non-operative treatments. The criteria for escalating to surgery include persistent, debilitating pain that significantly limits daily life, failure to respond to an intensive course of physical therapy, or the presence of a high-grade partial tear or a full-thickness tear that is not healing. Minimally invasive procedures, such as arthroscopy, are the standard approach.
During arthroscopy, a surgeon uses small instruments and a camera to visualize the joint and may perform a debridement, which involves removing damaged, inflamed tissue. For significant tears, the surgeon will repair the tendon by reattaching it to the bone using specialized anchors. Surgical intervention is typically followed by a prolonged period of immobilization and a comprehensive physical therapy program to restore strength and motion.