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Shoulder Tendonitis

Tendonitis means inflammation of a tendon. The rotator cuff tendons of the shoulder are especially prone to it, most often the supraspinatus.

Tendonitis means inflammation of a tendon. The rotator cuff tendons of the shoulder are especially prone to tendonitis, and the supraspinatus is the rotator cuff tendon most often involved. The supraspinatus runs across the top of the shoulder in a narrow space beneath the acromion, which is the bony shelf formed by the shoulder blade, and that confined position leaves it vulnerable both to direct injury and to repeated compression.

Tendonitis of the shoulder rarely occurs in isolation. A degree of bursitis, meaning inflammation of the fluid-filled gliding space between the tendon and the acromion, is often present alongside it, and the swollen tendon frequently catches in that space as the arm is raised, producing impingement. Because these problems overlap, treatment is usually aimed at the shoulder as a whole rather than at a single structure.

Symptoms

  • Aching pain along the outer side of the upper arm.
  • Moving the arm away from the body is particularly uncomfortable and can cause a deep aching pain.
  • Impingement symptoms are common, with the shoulder catching as the arm is lifted away from the body.
  • A degree of bursitis is often present alongside these symptoms.

Causes

  • Traumatic or repetitive injury. Tendonitis can follow injury to the rotator cuff tendons, either from repetitive strain over time or from a single event such as a fall onto the shoulder.
  • Calcium deposits. Tendonitis can also be linked to a build-up of calcium within the rotator cuff tendons. Calcium in these tendons is surprisingly common and frequently causes no problems at all. In some patients, however, the calcium provokes an inflammatory reaction, and the resulting condition is known as calcific tendonitis. Where that is the case, excision of the calcium may be carried out to relieve the symptoms. This is covered in more detail on the calcific tendonitis page.
Image of the shoulder showing an inflamed supraspinatus tendon of the rotator cuff beneath the acromion

Treatment

Tendonitis of the shoulder can be difficult to treat, and it is useful to separate two different situations: tendonitis occurring together with bursitis and impingement, which generally responds well, and so-called pure tendonitis, which does not.

Non-surgical treatment

Where the tendonitis is accompanied by bursitis and impingement, symptoms are often satisfactorily controlled with a steroid injection, with physiotherapy, or with both.

Pure tendonitis is, fortunately, uncommon, because it is more difficult to treat. It is typically a chronic overuse injury, and patients tend to reinjure the shoulder, often from fairly minor events. For this group the options are:

  • Prolonged rest together with physiotherapy.
  • Steroid injections, where rest and physiotherapy have not succeeded.
  • Platelet rich plasma (PRP) injections, which may give some relief.

Surgical treatment

Where tendonitis occurs with bursitis and impingement and symptoms persist despite injection and physiotherapy, an arthroscopic acromioplasty and bursectomy may be considered. This keyhole operation shaves the underside of the acromion and removes the inflamed bursa, creating more space for the tendon to move.

Arthroscopic surgery to decompress the rotator cuff can also help in some cases of pure tendonitis. It is important to be aware, however, that patients in whom tendonitis is the predominant problem may not respond adequately to surgery, and this is discussed honestly before an operation is planned. In many cases surgery is not needed at all.

Any procedure carries risk, including the risks of general anaesthetic, a small risk of infection, a small risk of nerve injury, and frozen shoulder, which can be precipitated by an operation. These risks are discussed in consultation.

What to do next

If you have aching down the outer side of your upper arm that is worse when you lift it, an assessment will establish which structures are involved and whether calcium or a rotator cuff tear is contributing. Closely related conditions are covered on the shoulder impingement, subacromial bursitis, calcific tendonitis and rotator cuff tear pages, and background on the joint is on the shoulder anatomy page.

To arrange an assessment, see consultation. The consultation FAQs explain what to bring, and the surgery FAQs answer common questions about having an operation. Other shoulder problems are listed under shoulder injuries and conditions.

This page is general information and is not a diagnosis. Individual circumstances vary, and the right treatment for you can only be determined after assessment. Any procedure carries risk; these are discussed in consultation.