Tendonitis of the Subscapularis

Tendonitis of the Shoulder (Tendonitis of the Rotator Cuff)

Rotator cuff tendonitis is the inflammation of the tendons around the shoulder joint, often leading patients to seek out their specialist shoulder doctor. They are one of the most frequent causes of shoulder pain and generally result from situations of overstraining, namely those that occur during sports practice, whether in high competition athletes or in weekend sportspeople.

Rotator cuff tendonitis are associated with conflict situations (or impingement) and with inflammation of the bursae that surround the shoulder joint, originating the so-called bursitis, such as sub-acromial bursitis (see below).

The diagnosis is usually made by discriminating the characteristics of the pain, specifying: the location; the inflammatory character; the triggering factor (usually high intensity exercise) and the response to anti-inflammatory medication, rest and ice.

Palpation of the pain site can help identify the shoulder structure affected by tendonitis.

Usually, ultrasound and magnetic resonance imaging of the shoulder are used as auxiliary diagnostic tests, due to their high sensitivity and specificity for soft tissue pathologies. Radiological exams may also reveal calcium deposits, characteristic of calcifying tendonitis of the cuff (see calcifications of the cuff).

The treatment for rotator cuff tendonitis, in general, involves: reducing physical activity (or even resting); taking anti-inflammatory medication and applying ice.

A rehabilitation programme (physiotherapy) adapted and prepared by your specialist in physical medicine and rehabilitation is important to speed up the process of recovery and eventual return to sport.

Surgery is rarely indicated for the treatment of shoulder tendonitis, which is why it should be carefully considered by your orthopaedic surgeon. It is reserved for chronic tendinopathies of the cuff that are resistant to conservative treatment and have associated partial or complete tears.

See below which are the most frequent tendonitis/bursitis of the shoulder and how to treat them individually:

Tendonitis of the Supraspinatus

Tendonitis of the supraspinatus usually causes pain on the lateral aspect of the shoulder, often radiating to the arm. It is inflammatory in nature and is therefore continuous and worsens at night.

Diagnosis is made by pain exacerbation tests through abduction movements and countered external rotation, confirmed by ultrasound, in which oedema and diffuse thickening of the tendon can be seen, with subsequent enlargement of the subacromial space.

Anti-inflammatory medication and rest, with the patient avoiding lifting the arms with loads above shoulder level, are essential for symptom relief.

Physiotherapy, and even the judicious use of corticosteroid infiltrations, may be necessary in cases that are more resistant to treatment.

Tendonitis of the Biceps (Biceps Tendonitis)

Biceps tendonitis occurs when the patient does repeated flexion/antepulsion exercises of the elbow and shoulder with heavy loads. It results in pain in the anterior region of the joint, exacerbated by counteracting movements.

The ultrasound image is very characteristic in that the biceps tendon can be seen surrounded by a large amount of synovial fluid, bicipital tenosynovitis.

In treatment, in addition to the methods already mentioned for shoulder tendonitis in general, echogenic procedures with infiltrations with corticoids diluted in lidocaine may be useful.

Subscapularis tendonitis is a rarer form of shoulder tendonitis and is usually associated with bursitis and subcoracoid impingement. It is an overuse lesion of the shoulder, triggered by repeated movements of internal rotation of the joint.

It causes pain in the anterior surface of the shoulder of an inflammatory nature. Its study may involve an MRI scan to study the structures adjacent to the tendon and screen for possible associated ruptures.

An adequate rehabilitation programme is essential to restore the balance of the shoulder rotator muscles, improving joint dynamics and controlling symptoms.