SHOULDER TENDINITIS & TENOSYNOVITIS |
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General Information
DEFINITION--Inflammation of a tendon (tendinitis) or the lining of a tendon sheath (tenosynovitis) in the shoulder. The lining secretes a fluid that lubricates the tendon. When the lining or the sheath becomes inflamed, the tendon cannot glide smoothly in its covering.
BODY PARTS INVOLVED
Tendons of the shoulder muscles. These muscles include the teres minor, infraspinatus, suprapinatus, subscapularis, deltoid and biceps. These muscles and tendons allow movement of the shoulder and hold the head of the humerus snugly against the glenoid cavity to stabilize the shoulder joint.
Lining of the tendon sheaths (tough, fibrous tissue covering the tendons).
Soft tissue in the surrounding area, including blood vessels, nerves, ligaments, periosteum (covering to bone) and connective tissue.
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SIGNS & SYMPTOMS
Constant pain or pain with motion of the shoulder.
Limited motion of the shoulder.
Crepitation (a "crackling" sound when the tendon moves or is touched).
Redness and tenderness over the injured tendon.
CAUSES
Strain from unusual use or overuse of the shoulder.
Direct blow or injury to muscles and tendons in the shoulder. Tenosynovitis becomes more likely with repeated injury.
Infection introduced through broken skin at the time of injury or through a surgical incision after injury.
RISK INCREASES WITH
Contact sports, especially football and basketball.
"Throwing" sports such as baseball.
Swimming or water polo.
If surgery is needed, surgical risk increases with smoking, poor nutrition, alcoholism or drug abuse, and recent or chronic illness.
HOW TO PREVENT
Engage in a vigorous program of physical conditioning before beginning regular sports participation.
Warm up adequately before practice or competition.
Wear protective gear such as shoulder pads, if they are appropriate for your sport.
Learn proper moves and techniques for your sport.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's examination and diagnosis.
Surgery (sometimes) to enlarge the tunnel of the tendon covering and restore a smooth gliding motion. The surgical procedure under general anesthesia is performed in an outpatient surgical facility or hospital operating room.
DIAGNOSTIC MEASURES
Your own observations of symptoms and signs.
Medical history and physical examination by your doctor.
X-rays of the shoulder and arm to rule out other abnormalities.
Laboratory studies:
Blood and urine studies before surgery.
Tissue examination after surgery.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated shoulder injury.
Adhesive tenosynovitis: The tendon and its covering become bound together. Loss of motion may be complete or partial. Surgery is necessary to remove the covering or transfer the tendon to a new area.
Constrictive tenosynovitis: The walls of the covering thicken and narrow the opening, preventing the tendon from sliding through. Surgery is necessary to cut away part of the covering.
PROBABLE OUTCOMETendinitis and tenosynovitis are usually curable in about 6 weeks with heat treatments, corticosteroid injections and rest of the inflamed area. Recovery is usually quicker if the inflammation is caused by a direct blow rather than by a strain or sprain.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDNone. This problem develops slowly.
CONTINUING CARE
Use a sling to rest the shoulder.
Apply heat frequently. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
MEDICATIONYou may use non-prescription drugs such as acetaminophen for minor pain. Your doctor may prescribe:
Stronger pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
Injection of the tendon covering with a combination of a long-acting local anesthetic and a non-absorbable corticosteroid such as triamcinolone.
ACTIVITYResume normal activities gradually.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may suggest vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when you can raise or work your hand overhead without pain, and supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of shoulder tendinitis or tenosynovitis.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms. Drugs used in treatment may produce side effects.
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