Shoulder tendonitis is irritation of the rotator cuff tendons: the four muscles that hold the head of the upper arm bone in the joint. It often goes together with shoulder bursitis, irritation of the small fluid-filled sac (bursa) above the tendons. It affects people who work with their arms above their head, athletes who throw or swing, and many people over 40 for no clear reason. With calcific tendonitis, calcium deposits build up in the tendon and can cause sudden, severe pain.
Symptoms
- Pain at the front or side of the shoulder, sometimes towards the upper arm.
- Pain when you lift your arm out to the side between shoulder height and head height (a painful arc).
- Pain when dressing, combing your hair or reaching for a high shelf.
- Pain at night when you lie on the shoulder.
- Weakness when lifting or turning the arm.
- With calcific tendonitis: sudden, very severe pain.
The pain usually starts gradually, after weeks of extra work or training. At first it hurts only with certain movements, and later at rest and at night too. With bursitis, the pain is often more spread out, at the side of the shoulder, and gets worse when you press there.
Why it happens
- Repeated work with your arms above your head: painting, assembly, stacking shelves.
- Sports such as tennis, volleyball, swimming and handball, and gym training with a lot of overhead exercises.
- A sudden increase in load, for example a new training programme.
- Wear of the tendons with age.
- Rounded shoulders and weak muscles around the shoulder blade, which leave less room for the tendons.
Tendons get used to load slowly. When you increase it a lot in a short time, they can’t cope and become irritated. That is why the treatment is gradual loading, not complete rest.
How we treat it
Kaloyan tests the individual tendons, watches how your shoulder blade moves and checks the strength of the shoulder. If he suspects a tear, he will refer you for an ultrasound scan. At the start, when the tendon is irritated, he usually uses ultrasound therapy to calm the tissue. Ultrasound therapy also suits calcific tendonitis. TECAR therapy helps with tight muscles and with pain that has lasted for months.
The most important part is exercise: gradual loading of the tendons and strengthening of the muscles around the shoulder blade. Kinesio taping supports the shoulder while you return to work or sport. You usually need 6–10 sessions over 3 to 6 weeks. Kaloyan will also tell you which movements to limit for a while, while still using your arm. With athletes, he also looks at technique: the swing in tennis, throwing, the stroke in swimming. If calcific tendonitis causes severe pain that doesn’t ease, Kaloyan will refer you to an orthopaedic doctor, who will decide whether a different treatment is needed.
What you can do yourself
- Cut down on work with your arms above your head for a while.
- Sleep on your good side or on your back.
- Short spells of cold for acute pain, heat for stiffness.
- Don’t stop moving your arm completely.
- If you train, lower the weights in overhead exercises instead of stopping everything.
- Work with your hands in front of your body and below shoulder height until the pain eases.
When to see a doctor first
See a doctor first in these cases:
- Sudden, very severe pain and you can’t lift your arm.
- Pain after a fall onto your arm or shoulder.
- The shoulder is hot, red or swollen, or you have a fever.
- Numbness and weakness in the whole arm.
