Shoulder Tendonitis
(Tendinitis of the Shoulder and/or Bicipital Tendonitis)

In tendinitis of the shoulder usually either the bicep tendon or the rotator cuff tendon is injured and/or inflamed, usually as a result of being pinched by surrounding structures. However, misdiagnosis can occur, as bursitis has many of the same symptoms. With this injury, the shoulder is sometimes stiff, and moving the shoulder just increases the pain. Statistical studies show that 8% to 13% of all athletic injuries involve the shoulder in one way or another. Early symptoms of shoulder tendonitis usually last for only a few days, but may recur or become chronic.

Overuse Tendonitis

Shoulder motions used during activities like tennis, golfing, throwing or overhead lifting may cause repetitive stress within the rotator cuff, leading to irritation, bruising or fraying of the tendon. This can cause shoulder pain and weakness in the joint.

Calcific Tendonitis

Calcific tendonitis refers to a build-up of calcium in the rotator cuff, and is often aggravated by an existing condition, such as Impingement or conventional tendonitis in the shoulder. When calcium builds up in the area, pain results from acute inflammation. Fluid movement of the joint is reduced. Calcium is deposited in the rotator cuff, between the humerus and acromion inhibiting the normal, friction-free movement of the joint. Impingement or tendonitis, which reduce the mobility of the joint leads to degenerative change and Calcium deposition.

Frozen Shoulder

A frozen shoulder is signified by pain and stiffness in the shoulder joint; limited range of motion and pain during nighttime rest are common symptons. A frozen shoulder (known also as adhesive capsulitis) is a condition that commonly occurs in older athletes. Frozen shoulder is five times more common in people with diabetes, though the reason for this is unknown. A lining of fibrous tissue, known as a capsule, surrounds the shoulder joint. The capsule is fully stretched when the arm is raised above the head, and it hangs down as a small pouch when the arm is lowered. Frozen shoulder occurs when this lining becomes thickened and swollen. It is thought a frozen shoulder may come on as a result of a previous injury, but also can come on for no apparent reason or may be triggered by a mild injury in the shoulder area. There are three phases to this condition, starting with pain, then stiffness and finally a stage of resolution as the pain eases and most of the movement returns. This process may take an awfully long time, sometimes as long as two or more years. Frozen shoulder may be associated with diabetes and is also seen in patients with scar tissue in their hands (a condition known as DupuytrenÕs contracture).

Torn Rotator Cuff
(Supraspinatus Tendinitis)

Many rotator cuff injuries occur gradually, though many are associated with sports injuries (especially baseball and swimming), falls on the shoulder, or an added injury due to shoulder dislocation in elderly folk. Read more about a torn rotator cuff here.

With a strained shoulder tendon, rest the area (this can be difficult to do, as many common daily activities work this tendon), apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further muscle injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by the use of Ultrasound applied over the affected area, as it reduces swelling quickly and increases blood flow to the area. If the patient gradually starting flexing and mobilising the area, the muscle would probably heal back close to normal.

However, this is not what typical person does; they may ice once or twice and rest a bit, but most often just take some Advil or Tylenol and continue to commence their activities. If the strain was minor, their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.

To prevent this the patient should apply ultrasound treatment on the area up to three times daily. Ultrasonic energy will naturally "work" the tendon, increasing its flexibily while softening and breaking down scar tissue - which is not something you want in your tendon. Scar tissue is inflexible (non-elastic), and can quickly lead to reinjury of the tendon later down the road. If you choose to use steriod injections or are using steriod injections, do NOT treat the area with ultrasound until 30 days after the last injection. Steriod injections break down the tissue in the treated area in an attempt to get it to re-heal properly. Applying ultrasound over areas injected with steriods may increase the damage and can potentially tear the tendon.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something radiant energy and ultrasound are great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average - which is well over 50%.

The most common cause of an tendon inflammation (tenosynovitis or tendonitis) is overuse of the affected tendon. Rest of the affected tendon is all that is required in some cases. Other treatments such as anti-inflammatory drugs or a steroid injection are sometimes needed. Infection of a tendon is an uncommon cause but needs treatment with antibiotics if it occurs.

What is tenosynovitis and tendonitis?

* Tendonitis means inflammation of a tendon. (It is sometimes spelled as tendinitis.)
* Tenosynovitis means inflammation of the sheath that surrounds a tendon (the sheath is called the synovium). Tenosynovitis can be caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.
These two conditions often occur together.

Never use Ultrasound over an area injected with a steroid (ie. cortisone) for at least 30 days.

Never use Ultrasound after surgery until your physician recommends and approves of it.