SHOULDER TENDINITIS

What is shoulder tendinitis/bursitis?
Shoulder bursitis and tendinitis are common causes of shoulder pain and stiffness. They indicate swelling (inflammation) of a particular area within the shoulder joint.

The shoulder joint is kept stable by a group of muscles called the rotator cuff as well as the bicipital tendin (the tendin that keeps the upper arm bone within the shoulder socket). When the rotator cuff tendin or the bicipital tendin becomes inflamed and irritated it is called rotator cuff tendinitis or bicipital tendinitis.

An area called the subacromial bursa lies in the space between the shoulder tendins. The bursa is what protects these tendins. Subacromial bursitis occurs when the bursa becomes inflamed.

Both conditions (shoulder bursitis and tendinitis) can cause pain and stiffness around the shoulder and may exist together.

What causes shoulder tendinitis/bursitis?
Tendinitis occurs as a result of sports injuries, by repetitive minor impact on the affected area or from a sudden, more serious injury. For instance, professional baseball players, swimmers, tennis players and golfers are susceptible to tendinitis in their shoulders, arms and elbows. Improper technique in any sport is one of the primary causes of overload on tissues including tendins, which can contribute to tendinitis. But you don't have to be a professional athlete to develop this condition. Anyone can get tendinitis, but it is more common in adults, especially those over 40 years of age. As tendins age, they tolerate less stress, are less elastic, and tear more easily.

Shoulder tendinitis/bursitis typically results from one or more of these factors:

• Age: 40 and over
• Frequent use of the arm in an overhead position or throwing motion, as in:
• tennis or other racquet sports
• swimming
• baseball
• Jobs such as overhead assembly work, butchering, or using an overhead pressing machine, heavy lifting
• Direct blow to the shoulder area or falling on an outstretched arm
• Other diseases or conditions that weaken shoulder muscles such as rheumatoid arthritis, gout, psoriasis, or an unusual drug reaction
• Infection (rare)

How is shoulder tendinitis/bursitis treated?
Treatment goals include reduction in pain and inflammation, as well as preserving mobility and preventing disability and recurrence.

The treatment recommendations may include a combination of rest, splints, heat and cold application. You may need more advanced treatments including:

• Corticosteroid injections from your health care provider. They work quickly to decrease the inflammation and pain.
• Physical therapy which includes range of motion exercises and splinting. This can be very beneficial.
• Surgery, if you are not responding to other treatments.

When should you seek medical advice?
Most cases of tendinitis go away on their own over time. It may take weeks to months to recover, depending on the severity. See your doctor if you experience pain that interferes with your normal day-to-day activities, have soreness that doesn't improve despite self-care measures, if you have recurrence, or if you have a fever and the area affected by tendinitis appears red or inflamed (swollen, warm). These signs and symptoms may indicate that you have an infection.

In addition see your doctor if you have other medical conditions that may increase your risk of an infection, or if you take medications that increase your risk of infection, such as corticosteroids or immunosuppressants.

How can you prevent shoulder tendinitis/bursitis?
Because most cases of tendinitis are caused by overuse, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. Underlying conditions such as improper posture or poor technique in sports or work must be corrected.

Apply these basic rules when performing activities:

• Take it slow at first and gradually build up your activity level.
• Use limited force and limited repetitions.
• Stop if unusual pain occurs.

The Cleveland Clinic  |  Contact Us  |  February 16, 2006