The tendons of the rotator cuff and bursa are located right next to each other just above the shoulder joint. The humerus (upper arm bone), the tendons of the rotator cuff, and the bursa (friction reducing membrane), move back and forth through a very tight space. When the arm is raised, the archway becomes smaller and compresses the tendons and bursa. Repetitive use of the arm can make the tendons and bursa prone to injury and inflammation. Shoulder pain caused by tendinitis and/or bursitis is often a result of overuse.
Bursitis: occurs when the bursa becomes inflamed and painful due to compression of the bursal sac.
Tendinitis: occurs when a rotator cuff tendon becomes inflamed, swollen and tender. Symptoms of tendinitis and bursitis usually last for only a few days, but may recur or become chronic.
Tendonitis is often accompanied by bursitis because they are located very close to each other.
Types of Tendinitis
- Overuse tendinitis
Shoulder motions used during activities like 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 tendinitis
Inflammation over a long period of time can sometimes result in a build-up of calcium deposits within the rotator cuff tendons. This leads to pain and loss of shoulder strength and motion.
- Impingement tendinitis
When the space is narrowed between the rotator cuff and the coracoacromial arch, the humerus can “pinch” the rotator cuff tendon into the arch. This can happen when the cuff is weak, the bursa is swollen or if there is a bone spur present. Tendinitis caused by impingement can occur with repetitive shoulder activities, such as sports or jobs involving overhead reaching.
- Rotator cuff tear
Severe tendinitis from long term impingement, degeneration, or sudden injuries like falling can cause partial or complete tearing of the rotator cuff tendon(s). This can result in more severe shoulder pain, weakness and loss of normal movement and function.
Diagnosis / Symptoms
- Shoulder pain which may radiate down the arm
- Pain is worse when the arm is lifted overhead or twisted
- In extreme cases, you may have pain while sleeping
- Overuse – Repetitive overhead motions are the most common cause of symptoms.
- Weak muscles – When the muscles are weak, more force is exerted on the tendons and bursa, causing inflammation and pain.
- Improper/ inappropriate swimming or throwing techniques.
- Strenuous training – One hard throw, weight lift or workout may start the problem.
- Previous injuries to the shoulder.
- Loose shoulder joint.
- Rest. Avoid things that hurt or make the pain worse the next day. Avoid the activity that started the problem. Your doctor may recommend a sling to immobilize the shoulder.
- Ice. Apply an ice bag (over a towel) to your shoulder at least twice a day for 20 minutes. Also apply ice after any activity that aggravates your shoulder pain.
- Medication. Your doctor may prescribe anti-inflammatory/analgesic medication (in tablet form) to relieve pain and inflammation while your body’s natural healing process goes on. An injection of cortisone with novocaine into the shoulder may be recommended. After receiving an injection, do not attempt any vigorous activities with your arm for at least two weeks.
- Physical therapy. Your doctor may send you to a physical therapist for exercises or other therapy. Exercises to strengthen the shoulder may help to prevent a recurrence.
- Surgery. Surgery may be required to treat shoulder tendinitis and bursitis if it becomes chronic or if there is a tear of the rotator cuff.
Returning to Activity
In severe cases, all activities using the arm should be avoided. When you go back to your activity, go back slowly. Warm up well and do flexibility exercises before starting. Avoid the overhead position and do not play for a long time. Gradually increase the intensity of your activity.
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