Shoulder Tendonitis Treatment
Tendonitis is a description of tissue rather than a diagnosis of a problem. Several tendons cross the shoulder, they become irritated for different reasons, and identifying which one is involved changes the treatment entirely. A patient told simply that they have shoulder tendonitis has been told very little.
Tendonitis is a diagnosis of the tissue rather than of the symptom, and identifying which tendon is involved changes the treatment. Steven Struhl, MD is board certified in orthopedic surgery and holds separate board certification in sports medicine, serves on the faculty of NYU School of Medicine, and has practiced in New York since 1991 as a Fellow of the American Academy of Orthopaedic Surgeons.
Which Tendon Is Involved
- Rotator Cuff Tendonitis: irritation of the cuff tendons, most often the supraspinatus.
- Biceps Tendonitis: inflammation of the long head of the biceps in its groove.
- Calcific Tendonitis: calcium deposits within a cuff tendon.
- Insertional Tendinopathy: degenerative change where the tendon meets bone.
The distinction between tendonitis and tendinopathy is worth understanding. True tendonitis is inflammatory and responds to anti inflammatory treatment. Tendinopathy is degenerative, meaning the tendon fibers themselves have changed, and it responds to progressive loading rather than to rest and medication. Chronic shoulder tendon problems are far more often the second than the first.
Symptoms
- Pain With Specific Motions: rather than constant pain, discomfort in particular positions.
- Pain At The Front Or Side: biceps tendonitis at the front, cuff tendonitis on the outer shoulder.
- Night Pain: common with cuff involvement, less so with biceps tendonitis.
- Stiffness After Rest: tendon pain that eases with gentle movement then returns with load.
How It Is Diagnosed
Examination locates the tendon. Specific tests load the biceps, the supraspinatus, and the subscapularis individually, which is how the source is identified without imaging. Ultrasound and MRI confirm the finding and identify whether the tendon is simply irritated or has begun to tear, which is the distinction that determines whether treatment stays conservative.
Treatment
- Load Management: reducing the aggravating activity while maintaining general movement.
- Progressive Loading: structured strengthening, which is the mainstay for tendinopathy.
- Anti Inflammatories: useful in genuinely inflammatory cases, less so in degenerative ones.
- Injection Therapy: corticosteroid used selectively, since repeated injection can weaken tendon.
Injections deserve a note of caution here. They provide real relief, and repeated corticosteroid injection around a tendon can compromise the tissue over time, which is why they are used deliberately rather than as a default.
Schedule a Shoulder Evaluation in New York City
Shoulder pain attributed to tendonitis that has not improved after a few months usually means either the wrong tendon was identified or the problem is degenerative rather than inflammatory, and those two possibilities lead to different treatment. Dr. Struhl evaluates shoulder tendon problems at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.
