Tendinosis, otherwise known as tendinopathy, of the shoulder is a disorder of a tendon of the shoulder joint. Tendons connect muscle to bone; ligaments connect bone to bone. Tendinosis is distinctly different from tendinitis which is an inflammation of tendon usually from an acute injury. Tendinosis on the other hand, is a degenerative condition from the wearing away of collagen over time as a result of chronic overuse. Collagen is the material that makes up a tendon. While these two conditions are similar and often present the same, it is important for an accurate diagnosis to be made in order to decide on the best treatment strategy for your shoulder. Tendinosis is often misdiagnosed as tendonitis. It is now thought that inflammation (the ‘itis’ of tendinitis) plays a small role in tendon injuries and that the majority of cases of pain involving shoulder musculature are a result of tendinosis rather than tendinitis.

Tendinosis is a chronic overuse of muscle injury. This disorder usually presents in a rotator cuff muscle when the shoulder is involved. Tendons have minimal blood supply and thus their rate of healing is slow. With tendinosis, the tendons are being broken down and worn away at a faster rate than the cells of the tendon are able to produce new collagen in order to replace the damaged parts. Some causes include:

● Age and normal wear and tear to the tendon
● Chronic overuse such as from a work-related situation or long-term participation in sports
● Poor posture: decreases the size of the shoulder joint because of a slouched position which leads to a forwardly positioned shoulder blade bones and an excessive rubbing of a tendon
● Weakness and stiffness of muscles
● Genetic predisposition leasing to instability of tendons
● Smoking: damages the production of collagen and interrupts blood supply

The symptoms that you may experience as a result of tendinosis of the shoulder may be one or all of the following:

Pain in the shoulder, either bilaterally or unilaterally, often worse in the evening and worsens with motion
Reaching and overhead motions will generally cause the most pain
Sleeping on the affected shoulder may cause pain
Strength is generally not affected as the tendon is intact

If You Are Experiencing Symptoms, Schedule an Appointment Dr. Burke Orthopedics Immediately.

One example as to the reason that is so critical to obtain an accurate diagnosis of tendinosis differentiating it from tendinitis is because some treatments aimed at healing the inflammation associated with tendinitis will actually hinder the recovery of tendinosis. For instance, the popular NSAID (non-steroidal anti-inflammatory drug) Ibuprofen has been shown to inhibit collagen production and repair. The proper treatments for a diagnosis of tendinosis are:

● Discontinuing of any known activity leading to overuse of the shoulder
● Adjustment of ergonomic position and correction of any anatomical or structural abnormalities
● A course of physical therapy in order to strength the appropriate muscles and restore proper range of motion, eccentric strengthening and transverse friction massage have been found to be beneficial and are both interventions that will be provided by a physical therapist
● Proper nutrition education and quitting smoking