Tendon Injuries in the Shoulder FAQ
June 13, 2018
The shoulder is the most flexible joint in the human body. It consists of the three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). It also consists of four joints: the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, and scapulothoracic joint. These structures allow you to move your arm up and down, in front of you, toward the back, and in circles. This wouldn’t be possible, however, without powerful tendons and muscles.
The rotator cuff is a group of four muscles and tendons that help move and stabilize the shoulder joint. The rotator cuff muscles include the:
- Supraspinatus which assists in moving the arm away from the midline of the body.
- Infraspinatus which assists in the external rotation of the arm.
- Subscapularis which assists in the internal rotation of the arm.
- Teres Minor which assists in the external rotation of the arm.
These tendons and muscles in the shoulder are subject to frequent stress each and every day. Activities at home (e.g. cleaning, painting, and gardening), activities at the workplace (e.g. lifting boxes), and recreational activities (e.g. golf, tennis, and swimming) can all contribute to a shoulder tendon injury.
What are the common muscle and tendon injuries in the shoulder?
The most common muscle and tendon injuries in the shoulder include:
- Rotator Cuff Tendinitis
- Shoulder Bursitis
- Shoulder Impingement Syndrome
- Rotator Cuff Tears
While these conditions are closely related, there are key differences among them.
Rotator cuff tendonitis and shoulder bursitis are both forms of soft tissue inflammation caused by either direct shoulder trauma or—more commonly—minor, repetitive trauma. In fact, inflammation due to overuse is so common, especially among athletes, that it is also called tennis shoulder, pitcher’s shoulder, and swimmer’s shoulder.
Tendonitis refers to inflammation of shoulder tendons while bursitis is inflammation of bursae, or the fluid-filled sacs that act as cushions within joints. Symptoms include pain, stiffness, swelling, and limited range of motion.
Shoulder impingement syndrome occurs when rotator cuff tendons are pinched between the upper arm bone and the shoulder blade. Consequently, this can also cause tendons to become inflamed leading to tendonitis or bursitis. It’s important to note, however, that while impingement is likely to lead to soft tissue inflammation, it can also occur without it.
Rotator cuff tears are classified in several ways depending on their cause and severity. Rotator cuff tears can either be traumatic (resulting suddenly from an injury), chronic (resulting from overuse), or degenerative (resulting from age-related tissue weakening). Moreover, a tear is classified as either a partial thickness tear (an incomplete tear) or a full thickness tear (a complete tear where the tendon is separated from the bone).
Who is at risk of a shoulder injury?
There are several factors that increase an individual’s risk. These include:
- While younger patients are subject to shoulder injuries, older patients face a higher risk due to the degenerative weakening of soft tissue as well as years of wear and tear. Degenerative disorders tend to begin at age 40 and become increasingly more common as people age.
- Prolonged use of the shoulder can cause small tears in soft tissue to gradually increase in size. This is especially common in occupations (e.g. painting) and sports (e.g. baseball) that require repetitive overhead movements.
- Smoking decreases the flow of blood and oxygen to soft tissue in the body. This makes tissue more susceptible to injury and slows the healing process. It also makes it difficult to build muscle that can prevent future injury.
Despite these risk factors, shoulder injuries are not limited to a specific demographic—accidents can happen to anyone. Falling on an outstretched arm or receiving a direct impact to the shoulder will cause an injury. It is crucial that you consult an orthopaedist following these incidents.
How do you know you have tendonitis or bursitis?
Rotator cuff tendonitis and bursitis share similar signs and symptoms. These include:
- Pain and swelling in the front of your shoulder
- Pain from raising or lowering your arm
- Shoulder stiffness and redness
- Loss of mobility and strength in the affected arm
- Pain that interferes with sleep
Patients with tendonitis may also experience a “clicking” sensation within their joint.
How do you know you have impingement?
Signs and symptoms of shoulder impingement include:
- Sudden pain when lifting your arm
- Constant ache in your arm
- Shoulder or arm weakness
- Pain that interferes with sleep
How do you know you have a rotator cuff tear?
Signs and symptoms of a rotator cuff tear include:
- Pain and swelling in the front of your shoulder
- Pain that continues to increase over time
Do shoulder injuries heal on their own?
Mild to moderate cases of tendonitis and bursitis can heal on their own with a combination of rest, conservative treatments, and patience. Mild tendonitis requires approximately 6-8 weeks to heal. Moderate tendonitis may require up to 12 weeks.
Rotator cuff tears are more difficult to generalize. This is primarily due to the fact that tears vary greatly in size, from microscopic injuries to complete ruptures in which the tendon is completely torn from the bone. Moreover, there is the possibility that the first injury leads to a secondary tear. It is best to consult a shoulder specialist if you suspect a torn muscle or tendon.
How do you treat shoulder injuries?
First and foremost, take a break from activities that repetitively stress your shoulder. Also, stop any activity that causes your tendons to flare up. If your occupation or sport requires you to use your shoulder, modify your activities to reduce the strain on your tendons as much as possible. In most cases, you will need to make long-term adjustments in order to avoid recurrent injury.
The RICE (rest, elevation, compression, and elevation) method can also help reduce symptoms and expedite recovery. The RICE method includes:
- Applying ice or a cold pack to your shoulder for 20 minutes every 3 to 4 hours
- Compress your shoulder with an elastic bandage
- Elevate your shoulder above the level of your heart when sitting or lying down
While the majority of shoulder injuries improve with conservative treatments, more severe injuries such as full-thickness rotator cuff tears do not heal on their own. These injuries require professional treatment from a shoulder specialist.
When should you see a shoulder specialist?
A healthy shoulder is vital for a number of occupations and sports, let alone everyday living. Unfortunately, shoulder tendons and muscles are highly susceptible to injuries that cause pain and disability. Moreover, certain conditions can occur without obvious signs or symptoms. Early diagnosis and treatment are key to maintaining an active lifestyle.
Dr. Robert Rolf at Beacon Orthopaedics & Sports Medicine is available to answer all of your questions regarding muscle and tendon injuries in the shoulder. You can attend one of Dr. Rolf’s monthly, free Shoulder Talks at Beacon West. Visit his page for a list of upcoming dates. You can also schedule an appointment with Dr. Rolf for a complete evaluation of your shoulder.