Generality
Shoulder tendonitis is the inflammation of one or more tendons belonging to the muscles of the so-called rotator cuff.
Generally, the symptoms of shoulder tendonitis at the beginning are mild or only appear when performing certain movements with the shoulder-arm complex.
The symptomatology of an advanced phase, however, is always present and makes it difficult to carry out numerous gestures of daily life, from driving to writing on the computer.
The diagnosis of shoulder tendonitis is based on physical examination, medical history or an MRI of the shoulder.
Normally, when faced with a case of shoulder tendonitis, doctors opt, as a first therapeutic choice, for a conservative treatment and reserve the use of surgery only in the event of a failure of conservative care.
Brief anatomical recall of the shoulder and rotator cuff
The shoulder is the even region of the trunk, situated in a latero-superior position, which marks the meeting between three very important bones: the clavicle, the scapula and the humerus .
A point of attachment between the arm and the trunk, the shoulder includes 5 joints, numerous muscles and a dense network of tendons and ligaments.
An important element of the shoulder, both as regards the anatomical-functional aspect and the clinical aspect, is the rotator cuff .
HEADSET OF ROTATORS
The rotator cuff is that important muscle-tendon complex of the shoulder, which gives stability to the latter and allows the movement of the arm in different directions of space.
To compose the rotator cuff are, exactly, four muscles and their respective tendons.
The muscles in question are:
- The supraspinatus muscle (or supraspinatus or supraspinatus ), in an upper position;
- The subscapularis muscle, in anterior position;
- The spinal muscle (or infraspinatus ) and the small round muscle, in the posterior position.
What is shoulder tendonitis?
The tendonitis of the shoulder is a condition of inflammatory nature, which has as its object one or more tendons of the muscles constituting the so-called rotator cuff.
| Table . Summary of the functions of the muscles constituting the rotator cuff. | |
 | Over-weighed : with its action it abducts and rotates outside (extraterridges) the arm, in synergy with the action of the deltoid |
 | Sub-post : with its action it externally rotates the arm and strengthens the capsule of the scapular humeral joint, stabilizing it. |
 | Underside : with its action it gives and rotates inward the arm (intrarotator) |
 | Small round : With its action, synergistic with the infraspinatus, the arm rotates weakly outwards |
Epidemiology
Shoulder tendonitis is a very common condition in those who practice sports - especially swimming, baseball and tennis - and in those who, due to work requirements, must continually bring their arms over their heads (eg, laborers, workers, etc.).
Causes
The main causes of shoulder tendonitis include:
- The partial or complete laceration of one of the tendons of the muscles belonging to the rotator cuff . In most cases, the laceration of the rotator cuff tendons is the result of a gradual process, dependent on the continuous repetition of wrong movements, which slowly injure the tendon fibers. More rarely, it can result from an acute traumatic event so intense that it tears off the tendon bands at one time.
- The accumulation of calcium deposits in the rotator cuff tendons . According to the most reliable theories, the normal process of aging and mechanical factors, such as the pressure that an arm raised above the head exerts on the tendons of the rotator cuff would cause the aforementioned accumulation of calcium deposits.
Shoulder tendonitis that depends on the accumulation of calcium deposits is better known as calcific tendinitis of the shoulder .
- The crushing of the supraspinatus tendon, resulting from an abnormal compression of the humeral head against the acromion of the scapula (NB: the supraspinatus tendon resides between the acromion of the scapula and the head of the humerus).
Shoulder tendonitis dependent on crushing of the supraspinatus tendon, operated by the acromion head, is better known as acromial conflict syndrome or shoulder conflict syndrome .
Alternative terms to indicate shoulder tendonitis
In the medical field, the condition of shoulder tendonitis is known by other names, whose use depends mainly on the causes.
The alternative names in question include: the aforementioned achromial conflict syndrome and shoulder conflict syndrome; functional shoulder overload syndrome ; swimmer's shoulder ; shoulder of the (baseball) pitcher; finally, the tennis player's shoulder .
Figure: position of the acromion of the clavicle, of the head of the humerus and of the supraspinatus muscle.
RISK FACTORS
They are definitely risk factors for shoulder tendonitis:
- Aging;
- The continuous and prolonged repetition of wrong movements with the shoulder;
- Always sleeping on the same side for years;
- The daily or almost daily practice of sports such as tennis, baseball or swimming;
- Work activities that force those who practice them to lift or hold their arms forward (ie: unskilled labor, carpenter's jobs, computer work, etc.);
- Traumatic injuries to the shoulder.
Symptoms, signs and complications
As a rule, at the beginning, shoulder tendonitis is responsible for mild symptoms or those that appear only when the person concerned makes certain movements with the shoulder-arm complex; at an advanced stage, however, shoulder tendonitis is the cause of intense symptomatology, such as to make it difficult to perform many of the most common daily manual tasks (eg driving, lifting small weights, writing to the computer, etc.).
Going into the details of the typical symptomatology of shoulder tendinitis, this generally includes:
- Pain during lowering of the shoulder from a raised position;
- Pain and swelling in the front of the shoulder and / or side of the ipsilateral arm;
- Sudden painful pangs in the shoulder, which appear with the lowering or elevation of the arm;
- Noisy movements of the painful shoulder;
- Joint stiffness in the affected shoulder;
- Shoulder pain so intense that it prevents sleep;
- Shoulder pain when trying to bring the arm behind the back;
- Loss of mobility and strength on the part of the arm connected to the painful shoulder.
COMPLICATIONS
Neglecting shoulder tendonitis leads to an aggravation of the inflammatory state . The more the inflammation becomes acute and the more the symptoms get worse (the pain increases, the swelling increases, the mobility is further reduced, etc.).
Neglected shoulder tendonitis is much more difficult to treat.
Diagnosis
In general, diagnostic investigations that lead to the detection of shoulder tendonitis and its causes consist of: physical examination, medical history and nuclear magnetic resonance of the shoulder .
Sometimes, to investigate the situation, doctors could add a shoulder ultrasound and a shoulder x-ray to the above tests.
IMPORTANCE OF CAUSING DIAGNOSIS
The identification of the causes that led to shoulder tendonitis is very important.
In fact, the knowledge of the triggers is of enormous help to doctors, in planning the most appropriate therapy.
Therapy
In general, when faced with a case of shoulder tendonitis, doctors opt, as a first therapeutic choice, for conservative (or non-surgical) treatment and reserve the right to resort to surgical therapy only in the event of failure of the conservative care.
In other words, first they give space to less invasive treatments, they observe the results and, only if the patient shows no improvement, they resort to surgical remedies.
Having said this, it is necessary to specify that, to influence the therapeutic choice, is also the severity of the condition: a tendonitis of the severe shoulder, the result of an acute traumatic event that has completely torn one or more tendons of the rotator cuff, will hardly heal with a treatment conservative, while it is highly probable that it needs surgical treatment right away.
CONSERVATIVE THERAPY
The basic conservative therapy for treating shoulder tendonitis includes:
- A period of rest of the shoulder . In particular, doctors advise against carrying out all those activities and movements that involve the appearance of pain;
- Applying ice on the painful area at least 4-5 times a day . To be effective, ice packs must last between 15 and 20 minutes, neither less nor more.
Readers are reminded that cryotherapy (ie the application of ice) has an extraordinary anti-inflammatory power, which many often underestimate;
- Taking non-steroidal anti-inflammatory drugs ( NSAIDs ), such as ibuprofen or naproxen.
Under certain circumstances and only upon medical decision, two more conservative treatments can be added to these conservative treatments, which are: physiotherapy and administration of intravenous corticosteroid drugs.
What are corticosteroids?
Corticosteroid drugs are powerful anti-inflammatories, whose prolonged or inappropriate use can have different side effects, sometimes even very serious (eg: glaucoma, hypertension, obesity, etc.).
SURGICAL THERAPY
The surgical treatment of severe shoulder tendinitis consists of an arthroscopy operation.
Arthroscopy is a minimally invasive surgical technique, involving the realization of 2-3 tiny skin incisions and the use of an instrument - the arthroscope - equipped with a camera and light.
During arthroscopy operations for the treatment of shoulder tendonitis, operating surgeons repair damaged tendons, inserting the arthroscope and the rest of the instrumentation into the small skin incisions previously made.
People undergoing surgery for the resolution of shoulder tendonitis must initially observe a period of rest and, secondly, follow a specific post-operative rehabilitation program lasting a few weeks.
The success of the surgical treatment in question depends not only on the ability of the operating surgeon, but also on the attention that the patient reserves for the post-surgical phase.
Prognosis
The prognosis of shoulder tendonitis depends on the severity of tendon inflammation and the timeliness of the diagnosis. In fact, healing from a severe and neglected shoulder tendinitis is much more complex than recovering from mild shoulder tendinitis diagnosed early.
Prevention
Do not overdo certain sporting activities, avoid the continuous repetition of wrong movements with the shoulder-arms complex, observe breaks during work activities that require the use of shoulders and arms, set up the computer station in order to preserve the health of the The entire human body and taking a correct position during night sleep are the main preventive measures, provided by doctors, to reduce the risk of shoulder tendonitis.
