Tendonitis in the shoulder is one of the main causes of pain at that level. Before mentioning the different alternatives, we have to treat tendonitis, we must clarify some concepts.
The nomenclature used for shoulder injuries has undergone changes in recent years, making it difficult to unify criteria when faced with certain clinical, radiological and surgical findings when addressing the shoulder with pain.
In such a way that, an attempt has been made to simplify the causes of shoulder pain, according to a classification that brings together anatomical and functional data. Namely:
· Subacromial bursitis, calcareous tendinous bursitis, supraspinatus tendonitis, rotator cuff impingement, rotator cuff tear, partial or total.
· Frozen shoulder
For practical purposes, we speak of tendinitis when the problem is located in the rotator cuff, either due to wear or partial or total rupture.
70% of patients with shoulder pain originate from the rotator cuff.
The pain associated with rotator cuff injury can be described as fixed shoulder pain, exacerbated by arm movements and simple manual tasks, particularly arm movement backward in the back or over the head.
The rotator cuff is an anatomical structure made up of 4 tendons of vital importance for the wide mobility of this joint.
Repetitive movements, joint vibration, or weights for a long time, lead to wear or even rupture of the rotator cuff.
Osteophytes (spicules or prominent fragments of bone tissue) can also form around the bones near the joint, resulting in increased friction and irritation of the tendons and adjacent mobile structures.
How to treat tendonitis in the shoulder?
Inquire about physical activities, weights, sports, or any triggering factor for tendonitis. Educate the patient about better postures, movements, stretches and know the limitations that must be taken into account to avoid recurrence of shoulder pain due to tendinitis.
Conservative treatment of shoulder tendonitis
· Local ice for the first 48 hours, every 4 hours.
· Rest of the joint, avoid more stress on the shoulder that can cause more inflammation or damage.
· Physical exercise with professional guidance.
· Physiotherapy, with exercises at home.
· Local injection with steroids.
· Arthroscopy in symptomatic patients is currently the preferred surgery, due to the rapid recovery and less muscle injury.
· Rupture of the bursa greater than 3 mm.
· Joint rupture less than 6 mm.
· Osteophyte removal.
· Joint replacement in severe cases.
Other proposed treatments
Multiple treatment alternatives have been tried for cases of rotator cuff damage and subacromial injuries. Some have proven to be effective, so their use is recommended, but it must always be the specialist who decides, according to the exact damage of the joint that each patient has.
The important thing is to know that there are many alternatives before proceeding with surgery or invasive treatment.
· Acupuncture: not for rotator cuff rupture, but for other medical conditions of the shoulder.
· Directed exercises:
· Scapular stabilization exercises.
· Rotator cuff exercises.
· Shoulder exercises:
· Biomechanical analysis.
· Proprioception and balance exercises.
· Specific agility and sport exercises.
· Physiotherapy in real time with ultrasounds.
· Soft tissue massage.
· Electrotherapy and local modalities.
· Kinesiology tape.
· Scapulohumeral rhythm exercises.
· Laser: with better response than ultrasound.
· Electrical stimulation: with few results.
· Conventional or neuroablative radiofrequency (heat techniques).
· Pulsed radiofrequency on the suprascapular nerve.
· Intra-articular hyaluronic acid, under study.
· Suprascapular nerve block.
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