Understanding shoulder tendinopathy
Shoulder tendinopathy is a dysfunction of the shoulder tendons, likely occurring due to damage. This can make it painful and difficult to move the shoulder. In this article, a consultant orthopaedic surgeon, Mr Samirul Imam, explains how shoulder tendinopathy typically presents and how it is treated.
What is shoulder tendinopathy?
The rotator cuff tendons work in harmony to help keep the shoulder in joint and functioning normally. Tendinopathy upsets this balance. It often has no obvious cause but can be the result of an injury, particularly those incurred during sports or repetitive activities. Tendinopathy refers to both tendonitis, when the tendon becomes irritated, and tendinosis, where the tendon has little microtears in several places (accompanied by less swelling). In more severe cases it can result in complete or partial tendon tears. Typically symptoms appear over time but in the case of injury, symptoms can be immediate.
When experiencing shoulder tendinopathy, the shoulder area may feel:
- Sore or achy
- Sensitive to touch
- Swollen
- Weak and difficult to move around
- Sharp pain when moved or engaged
There may also be a clicking or popping sound when the shoulder is moved.
Diagnosing shoulder tendinopathy
- When diagnosing shoulder tendinopathy, a doctor will take a thorough history prior to asessing the shoulder with a physical examination. This then leads on to more guided tests which can include:MRI scan
- Arthroscopic surgery
- X-rays
Tendinopathy will be easily visualised with scans that show soft tissue structures. From there, doctors can determine the exact location of the ailment.
Treating shoulder tendinopathy
When treating shoulder tendinopathy, it is important that patients avoid pain inducing activities. This may be until the tendon gets better or until the patient is able to seek medical advice in order to heal or treat their tendons with a lower possibility for complications or long term damage.
Within the first 48 hours after injuring the shoulder, it is recommended to ice the site and rest. After a few days have passed, it can be helpful to use heating cream to keep the muscles from becoming stiff. Medications may be prescribed to help the patient manage the pain, and can include NSAIDs and steroid injections to control inflammation.
Physical therapy is highly recommended early on so that the shoulder can regain strength and flexibility, with a regimen of daily exercises and stretches. In some this alone can cure the problem.
On occasion surgery may be an option, especially if all other options have failed. One of the most common surgical procedures for the shoulder is an arthroscopy. “Keyhole” surgery is a minimally invasive operation that is both useful for diagnosis and treatment. The surgeon will make a small incision around the shoulder to insert a camera (the arthroscope). The surgeon is then able to see the inside of the shoulder and with the aid of a few instruments they are able to treat the site of pain.