Shoulder tendonitis involves the irritation or inflammation of a tendon within the shoulder joint, most commonly affecting the tendons of the rotator cuff or the biceps tendon. This painful condition typically arises from overuse, repetitive motions, or injury, leading to symptoms like a dull ache, tenderness, and reduced range of motion. Treatment for shoulder tendonitis follows a progressive, stepped approach, beginning with conservative, non-invasive strategies before moving toward more targeted medical interventions or surgery for persistent cases.
Initial Non-Invasive Management
Patients should implement relative rest by modifying or avoiding activities that aggravate the shoulder, such as repetitive lifting or overhead motions, rather than completely immobilizing the joint. Complete inactivity can sometimes lead to stiffness, so the focus is on protecting the irritated tendon from further strain.
Applying a cold compress or ice pack to the affected area helps reduce pain and manage localized swelling. Cold therapy should be administered for approximately 20 minutes at a time, several times throughout the day. Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can also be taken to decrease both pain and the inflammatory response.
Structured Rehabilitation Programs
When initial self-care measures prove insufficient, a structured rehabilitation program, typically involving physical therapy (PT), is necessary for recovery. The primary goals of this guided therapy are to reduce pain, restore the full, pain-free range of motion, and improve the dynamic stability of the shoulder joint. This process moves beyond passive rest to actively recondition the shoulder and prevent recurrence.
A therapist will introduce specific therapeutic exercises designed to strengthen the muscles surrounding the shoulder, focusing particularly on the rotator cuff and the scapular stabilizers. Strengthening the rotator cuff muscles is necessary for maintaining shoulder joint stability, which helps relieve stress on the inflamed tendons. These exercises often incorporate eccentric strengthening to build capacity and minimize stress on the joint.
Manual therapy, which includes hands-on techniques from the therapist, may also be used to improve joint mobility and further reduce pain. Range-of-motion exercises, such as pendulum swings and cross-body stretches, are employed early in the program to regain flexibility and address any stiffness that may have developed. Consistency with the prescribed home exercise program is essential for achieving recovery.
Targeted Medical Interventions
If an adequate trial of structured rehabilitation and initial non-invasive management does not provide sufficient relief, a physician may recommend more targeted medical interventions. The most common of these is a corticosteroid injection, often delivered into the subacromial space, which is the area directly above the rotator cuff tendons. Corticosteroids are powerful anti-inflammatory medications that can provide significant short-term pain relief, typically lasting several weeks to a few months.
This temporary pain reduction creates a window of opportunity to more effectively participate in physical therapy and regain strength and mobility. However, steroid injections do not directly promote tendon healing and are generally limited in number due to the potential for adverse effects on tendon tissue with repeated use. A physician may use ultrasound guidance to ensure precise placement of the injection into the target area, which is typically the inflamed bursa rather than the tendon itself.
Alternative targeted treatments are also available, which focus on promoting tissue repair rather than solely reducing inflammation. Platelet-Rich Plasma (PRP) injections involve concentrating a patient’s own platelets, which contain growth factors, and injecting them into the injured area to stimulate healing and regeneration. Procedures like dry needling or tenotomy are sometimes used to create a controlled injury within the damaged tendon, aiming to restart the body’s natural healing cascade.
Surgical Considerations
Surgery is generally reserved for a small proportion of patients whose symptoms have failed to improve after a prolonged course of non-operative management, typically ranging from six to twelve months. The majority of shoulder tendonitis cases resolve with conservative treatment, so non-surgical options must be thoroughly exhausted first. The presence of a significant or complete tendon tear, which often accompanies chronic tendonitis, is another primary reason for surgical intervention.
The most common surgical approach is arthroscopic, a minimally invasive technique that uses small incisions and a camera to view and operate within the joint. The goal of the procedure is often to address underlying structural issues, such as removing inflamed tissue (debridement) or correcting bone spurs that are impinging on the tendon. For cases involving a tear, the surgery will focus on repairing and reattaching the damaged tendon tissue.
While surgery can be effective in reducing severe pain and improving function, it is not a substitute for the intensive rehabilitation that must follow. The decision to proceed with an operation is based on the severity of the injury, the patient’s individual goals, and the failure of all prior conservative efforts to restore a functional, pain-free shoulder.