Shoulder Tendonitis: Signs You Have It and How to Treat It

Your shoulder is a mighty joint. It’s made up of many different structures, including tendons and muscles, that allow for a wide range of motion in your arm. Your shoulder joint’s mobility is what allows you to reach behind your back to scratch an itch or overhead to throw a ball or grab something off a high shelf.

Since your shoulder is integral to so many movements, there’s potential for it to get injured or inflamed. Pain in your shoulder may be a symptom of shoulder tendinitis (tendonitis), a condition that occurs when one or more of your shoulder tendons becomes irritated. Pain from shoulder tendinitis can make many daily activities and tasks more challenging.

The good news: Your shoulder muscles and tendons are strong and resilient, and there's a lot you can do to help them recover and avoid further irritation, says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health.

Read on to learn more about shoulder tendinitis: what it is, what causes it, and how to treat it with exercises from our Hinge Health physical therapists.

What Is Shoulder Tendinitis?

“Shoulder tendinitis is caused by an irritation or overuse of one or more of the tendons in your shoulder,” explains Dr. Kimbrough. 

To understand shoulder tendinitis, it helps to have a crash course in shoulder anatomy. Your shoulder is made up of three bones:

• Your upper arm bone (humerus)

• Your shoulder blade (scapula)

• Your collarbone (clavicle)

The shoulder is referred to as a ball-and-socket joint because the head of the humerus fits into the socket of the scapula. What helps keep your arm in your shoulder socket? Your rotator cuff. The rotator cuff is made up of tendons whose muscles originate from the shoulder blade and attach to the head of the humerus, forming a "cuff" around it. “These tendons help to stabilize and move your shoulders,” explains Dr. Kimbrough. When these tendons become irritated or inflamed, it can cause shoulder tendinitis, leading to pain that can make it harder for you to engage in everyday activities. 

Shoulder tendinitis can also be caused by shoulder impingement, which can occur when the rotator cuff tendon gets irritated and inflamed as a result of reduced space around the tendon. When this occurs, it can rub against (or impinge on) the surrounding bones, causing discomfort. 

Your biceps tendon can also contribute to shoulder tendinitis when it becomes inflamed. This can lead to pain in the front of the shoulder that gets worse when you lift, pull, or reach overhead.

Shoulder Tendinitis Versus Bursitis

It’s easy to confuse shoulder tendinitis and shoulder bursitis because they often result in similar symptoms, and oftentimes they are overlapping conditions, occurring together. “With shoulder tendinitis, there’s an inflammation or irritation of the shoulder tendons that attach muscle to bone,” explains Dr. Kimbrough. “Bursitis is an irritation of the bursa, which is a fluid-filled sac between your rotator cuff and the bone on top of your shoulder.” Both conditions can lead to swelling and pain.

“Oftentimes, they end up paired together, which is fine as treatment is the same,” says Dr. Kimbrough.

Symptoms of Shoulder Tendinitis

In many cases, the early signs of shoulder tendinitis are mild, says Dr. Kimbrough. It may start as very subtle pain and stiffness. “You may notice it when you lift or reach for something,” says Dr. Kimbrough. “You may also experience discomfort when you lower your arm.” Over time, shoulder tendinitis symptoms can worsen and often include:

• Shoulder pain that’s present both with activity and at rest.

• Pain with lifting and reaching movements like brushing your hair.

• Loss of strength and range of motion.

• Trouble doing any activity where you place your arm behind your back, like zipping a dress.

• Pain that worsens when you lie on the affected shoulder.

Shoulder Tendinitis: A Hinge Health Perspective

Learning about conditions that cause shoulder pain can be alarming. We know from Hinge Health members and research studies that anatomical labels like these can backfire when it comes to your treatment and recovery. When people hear they may have a condition like tendinitis, it can cause feelings of panic, like you have something "wrong" with your shoulder that needs to be fixed. This way of thinking about pain is largely outdated.

Pain is more complex than simply what may or may not be happening in your shoulder joint. Other factors, like life stressors, can also play a big role in how you experience pain. And for most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same. 

Movement — through physical and exercise therapy — builds strength, flexibility, and resilience to pain. “With tendinitis, it’s often very safe to stay active,” says Dr. Kimbrough. “In fact, strengthening and flexibility exercises will be what gives you the most relief from shoulder tendinitis pain.” 

If you feel like it hurts too much to move your arm, consider physical therapy. A physical therapist (PT) can create a treatment plan that gets you back to all the activities you enjoy. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Shoulder Tendinitis Causes

Shoulder tendinitis is usually caused by pushing your body to do a bit more than it’s ready for. “It’s often the result of overuse,” explains Dr. Kimbrough. “We also see it a lot in people whose jobs require a lot of overhead movement throughout the day, such as painters and mechanics.” There are also certain sports with a lot of overhead activity where it’s more likely to happen. These include:

• Swimming

• Tennis

• Weightlifting

• Volleyball

• Baseball

And remember: Pain during these activities doesn’t mean you have to stop doing them. It’s just a sign that your shoulder joint and muscles may need to get stronger in order to support you during these movements.

There are also several other factors that put you at increased risk of developing shoulder tendinitis, adds Dr. Kimbrough. These include:

• Muscle imbalances. “If there is a weakness or lack of flexibility in a particular shoulder muscle, it can put an excessive load on the tendon, which can lead to tendinitis,” explains Dr. Kimbrough.

• Normal aging. “Your tendons get less flexible with age, so they are more likely to develop stress and strain over time,” says Dr. Kimbrough.

• Certain health conditions. If you have high cholesterol or type 2 diabetes, you may be slightly more likely to develop any form of tendinitis, including shoulder tendinitis, according to research.

Treatment Options for Shoulder Tendinitis

The following shoulder tendinitis treatments can provide relief for most mild to moderate cases.

Ice and heat. Put ice or heat on your shoulder for 15-20 minutes up to four times per day. Ice is often more helpful in the first few days after tendinitis sets in to reduce pain and swelling, says Dr. Kimbrough. After about three days, you can keep using ice or switch to heat. Test each out to see if one helps reduce symptoms like pain and stiffness more than the other.

Exercise therapy. Initially, you’ll want to avoid activities that aggravate symptoms, so that your shoulder tendinitis can calm down, says Dr. Kimbrough. This usually includes limiting most overhead activities. But after a couple days, you can start doing stretching and strengthening exercises (like the ones listed below). This will help to increase blood flow to the area and promote healing. One review of 54 studies in the British Journal of Sports Medicine found that exercise therapy is the first-line of therapy to improve pain, function, and range of motion.

Shoulder taping. Kinesio taping or sports taping can help relieve tendinitis pain and allow you to do some day-to-day activities while you heal, says Dr. Kimbrough. A PT or healthcare provider can show you how to tape on your own.

Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for shoulder tendinitis pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

Acupuncture. There’s some evidence that acupuncture can be helpful to treat shoulder pain, including pain related to tendinitis. But it should be used in addition to the above treatments, especially exercise therapy, stresses Dr. Kimbrough.

The above shoulder tendinitis exercises are recommended by Hinge Health physical therapists. Not only do they work your shoulders to help relieve and prevent shoulder tendinitis, but they also help to strengthen all the structures that support your shoulders, including your neck, arms, and upper back. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Shoulder Tendinitis Prevention

Hinge Health physical therapists recommend the following three tips to prevent shoulder tendinitis:

• Take movement breaks. “I recommend everyone do small ‘movement snacks’ throughout the day, especially if you’re doing something with a lot of repetitive movement,” says Dr. Kimbrough. If you sit at a computer typing, for example, stand up and do some of the shoulder stretches above to take pressure off stressed muscles and tendons.

• Be smart about smart devices. Try to limit the amount of time you spend hunched over and looking down at smart devices, as that can stress your neck, upper back, and shoulders. If possible, try to use a stand to prop up your phone or tablet on a table.

• Sleep strategically. There's no right or wrong sleeping position, but if you have shoulder pain there are a few steps you can take to avoid waking up with a sore shoulder, advises Dr. Kimbrough. If you’re a back sleeper, try placing a pillow between your torso and shoulders. Side sleeper? Consider using pillows on your slumbering side to keep your arm in a straight, neutral position.

PT Tip: Sit Up

“When you sit for long periods of time, try to sit upright with your chest facing forward,” advises Dr. Kimbrough. “It puts your shoulders in better alignment and opens up your tendons, which may improve your ability to reach overhead without pain.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Haik, M. N., Alburquerque-Sendín, F., Moreira, R. F. C., Pires, E. D., & Camargo, P. R. (2016). Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. British Journal of Sports Medicine, 50(18), 1124–1134. doi:10.1136/bjsports-2015-095771

2. Trofa, D. P., Obana, K. K., Herndon, C. L., Noticewala, M. S., Parisien, R. L., Popkin, C. A., & Ahmad, C. S. (2020). The Evidence for Common Nonsurgical Modalities in Sports Medicine, Part 1. JAAOS: Global Research and Reviews, 4(1), e1900104. doi:10.5435/jaaosglobal-d-19-00104

3. AlRuthia, Y., Alghadeer, S., Balkhi, B., Almalag, H. M., Alsobayel, H., Alodaibi, F., Alayoubi, F., Alkhamali, A. S., Alshuwairikh, S., Alqahtani, F. N., & Alsanawi, H. (2019). Efficacy of acetaminophen versus ibuprofen for the management of rotator cuff-related shoulder pain: Randomized open-label study. Saudi Pharmaceutical Journal, 27(6), 882–888. doi:10.1016/j.jsps.2019.06.001

4. Lin, M.-T., Chiang, C.-F., Wu, C.-H., Huang, Y.-T., Tu, Y.-K., & Wang, T.-G. (2019). Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials. Archives of Physical Medicine and Rehabilitation, 100(2), 336-349.e15. doi:10.1016/j.apmr.2018.06.028

5. Choi, S., Lee, J., Lee, S., Gi Young Yang, & Kun Hyung Kim. (2021). Acupuncture for Symptomatic Rotator Cuff Disease: A Systematic Review and Meta-Analysis. Journal of Acupuncture Research, 38(1), 20–31. doi:10.13045/jar.2020.00458

6. Simons, S. M., & Kruse, D. (2019). Rotator cuff tendinopathy. UpToDate. https://www.uptodate.com/contents/rotator-cuff-tendinopathy