What is shoulder tendinitis?
The term tendinitis corresponds to the inflammation of a tendon, in which micro tears and areas of necrosis occur.
Tendonitis in the shoulder can mainly affect 5 muscles: the long portion of the biceps brachii and those that constitute the so-called "rotator cuff":
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapular
What causes tendinitis of the shoulder?
The causes that predispose to glenohumeral or shoulder tendonitis are determined by some factors such as the following:
• Age: they occur more frequently after the age of 40.
• Mechanical factor: due to maintained positions of arm elevation (very frequent movement in certain work activities and launch sports), which implies an increase in the friction forces in the tendon and, therefore, an overuse, which would generate microtrauma of the tendon structure.
• Vascular factor: mainly affects the supraspinatus and infraspinatus muscles; These muscles have a poorly irrigated area in their tendon, constituting a favorable place for the appearance of degenerative processes.
Symptoms of shoulder tendinitis
All the tendinitis of the muscles mentioned have common symptoms:
• Inflammatory type pain: it is characterized by decreasing during rest and increasing at night.
• Pain from the pressure exerted on the tendon.
• Pain in performing active shoulder movements
• Pain when stretching the mucular tendon.
When tendinitis occurs in any of the rotator cuff muscles, there are some more specific symptoms, for example:
• If it corresponds to a supraspinatus tendinitis: the pain is concentrated in the deltoid region (lateral part of the shoulder), the pressure on the tendon is sensitive (located in the upper external part of the shoulder), pain appears when the arm separates and There is a painful arc between 60 and 120 degrees of separation.
• If it is located on the infraspinatus tendon: the pain is located on the anteroexternal aspect of the shoulder, there is special sensitivity to pressure on the tendon (located on the back of the shoulder) and to the stretching of the tendon and pain appears on movements assets of separation and external rotation of the arm.
• If it is located on the tendon of the long portion of the biceps brachii: the discomfort is located on the anterior aspect of the shoulder and the arm, pain occurs on the anterior aspect of the shoulder when the tendon is stretched and in the resisted movements of flexion of the shoulder and elbow.
Physical Therapy in shoulder tendinitis
The general objectives of physical therapeutic treatment are:
• Ease the pain.
• Reduce or eliminate inflammation.
• Maintain or regain joint mobility.
• Strengthen weakened muscles.
• Obtain shoulder functionality for work and / or sports activities.
Physical therapeutic treatment must be adapted to each of the three evolutionary phases of the process:
• Acute phase: The predominant symptoms are pain and inflammation, the reduction of which is the main objective of this phase. Joint rest and the application of cold for 20 minutes every four hours is necessary, especially before going to Physiotherapy sessions. During the same ultrasound can be applied (to reduce inflammation) and pain relieving currents. Usually, the patient overloads the cervical muscles, and it is necessary to treat this as well.
• Subacute phase: Pain and inflammation have reduced, but mechanical discomfort persists, especially in movements where the tendon is stretched. The Physiotherapy sessions consist of: ultrasound application, massage of the shoulder muscles, deep transverse massage and passive, active, resisted and free mobilizations of all the joints that are part of the shoulder. To reduce the intensity of the discomfort caused during the treatment, the session should be ended with the application of analgesic currents and cold.
• Recovery phase: The pain and inflammation have completely disappeared. The goals of this phase are to regain lost mobility and combat muscle atrophy. Physiotherapy sessions focus mainly on the application of heat (can be with microwave or short wave), stretching exercises of the affected tendon, passive mobilizations to recover the last degrees of mobility and muscle strengthening techniques.
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