Shoulder tendonitis in short is an inflammation injury to the tendons of the rotator cuff muscles. However, inflammation may not always be present in shoulder injuries therefore those injuries can be referred to as rotator cuff tendinopathies.
The most common cause of tendonitis is repeated micro trauma to the RC tendons. As previously discussed, RC impingement should not occur during NORMAL shoulder function. However when this repeated impinging movement occurs, your tendons can become inflamed. It is also possible to have shoulder bursitis in conjunction with RC tendonitis.
- Shoulder clicking and/or pain when your arm is raised to shoulder height
- Pain while laying on the shoulder
- Pain present in the shoulder and upper arm (can refer to as low as your elbow)
- Pain and or clicking with overhead movements or behind the back
- Potentially even pain at rest with progressive tendonitis
Unfortunately, many other injuries can accompany RC tendonitis as mentioned above regarding bursitis, biceps tendonitis, calcific tendonitis which can eventually lead to rotator cuff tears.
GOOD NEWS! Most RC tendonitis is reversible and can be successfully treated! Great, but how? Consult your physical therapist who would assess your shoulder biomechanics and utilize special testing for diagnostic purposes to correct your shoulder movements and prevent future impingement episodes or subsequent RC tendonitis. There are a number of phases in rehabilitation of your shoulder injury.
- Pain relief and anti-inflammatory strategies
- Rest your shoulder and prevent excessive movements that cause pain, especially those requiring your arm to be overhead or behind your back
- Ice can help to reduce swelling and inflammation, apply for 20-30 minutes at a time and use it a few times a day when you feel aching.
- Anti-inflammatory medicine (avoid this during the initial 2-3 days as it can encourage additional bleeding)
- Support your shoulder by wearing a sling or using tape for additional support since gravity will make your arm feel heavier overtime. You may even sleep with a pillow under your arm to allow the structures in your shoulder joint to be at rest.
- Regain full range of motion
- Your muscles may be fatigued and tight as a protective mechanism to guard your shoulder. Scar tissue may form as the tendonitis heals so it’s important to lengthen and orientate your healing tissue through joint mobilizations, massage, muscle stretches and light-active assisted exercises. Your therapist can guide you through this process to ensure proper healing and progression to obtaining full pain free motion.
- Restore scapular control
- Scapula = shoulder blade, which plays a critical role in proper bio mechanical movement of the arm and is a major cause of shoulder impingement (discussed in the previous post).
- Normal shoulder blade-shoulder movement is scapulohumeral rhythm which is required for pain-free and strong shoulder function.
- Restore normal neck-scapulothoracic shoulder function
- Your neck and mid back (thoracic spine) are important in the rehabilitation of shoulder pain as they are more closely related than you think.
- Some treatment directed at your neck or upper back will be required to ease pain and improve shoulder movement.
- Restore rotator cuff strength and function
- Stabilization of the shoulder joint is the key to building further strength to improve overall function and pain levels.
- Exercises for the RC muscles need to include load and position to accommodate for your specific injury.
- Restore speed, power, agility and proprioception
- Important to prevent recurrence of injury and improve joint performance
- Depending on your sport or lifestyle, speed, agility and proprioception should be customized according to your niche.
- Return to sport or work
- Important to follow a maintenance program for injury prevention.
(Disclaimer: Guidelines followed by John Miller from Physioworks)