Rotator cuff tendonitis and biceps tendonitis are common causes of shoulder pain. The rotator cuff tendon is the tendon of 4 shoulder muscles that blend together and control all of the rotational movements of the shoulder. The 4 rotator cuff muscles are sometimes called the SITS muscles (supraspinatus, infraspinatus, teres, and subscapularis). The biceps muscle is familiar to everyone, and its long tendon is located in the front of the shoulder.
The rotator cuff tendon and the biceps tendon have the rare distinction of being located between bones. They run between the numeral head (the ball of the shoulder) and the acromion (the top part of the shoulder socket which is located on the outer part of the shoulder blade). As such, these tendons are prone to getting pinched and rubbed between the bones (known as impingement syndrome) and consequently frequently get frayed and develop tears. The bicep tendon occasionally frays so much that it can rupture when performing heavy lifting.
The most common causes for shoulder pain are tendinitis and tendinosis. Tendinitis is simply inflammation of a tendon, whereas tendinosis is a condition wherein inflammation is not present but the tendon itself is actually breaking down (similar to how a rope frays). This can come on following a significant trauma but usually occurs following long term overuse, or impingement.
Muscles have a rich blood supply whereas tendons and ligaments do not. Consequently, if you were to injure a muscle, the pain normally goes away within just a few days because its rich blood supply helps it to quickly heal. However, overworked or strained tendons and ligaments result in torn fibers that often do not heal because there is such a poor blood supply present.
The worst type of rotator cuff tendinosis is calcific rotator cuff tendinosis. This is where the lack of blood flow in the injured tissue leads to the buildup of calcium within the damaged part of the tendon. This creates a lump in the tendon, making it even more prone to fraying and impingement between the humeral head and the acromion.
The best treatment for rotator cuff tendonosis, calcific rotator cuff tendonosis, and biceps tendonosis is shockwave therapy. With an 85% - 90% success rate, shockwave therapy is a treatment wherein powerful sound waves travel through the damaged tendon and create micro trauma that stimulates the body to repair itself by angiogenesis (a process wherein new arteries grow in the tendon). This increase in blood flow allows the tendon to heal without damaging the surrounding skin and other tissues.
After healing the damaged tendon and relieving the pain, it is recommended that you do shoulder rehab exercises to strengthen the external rotator muscles which have usually weakened. This is also an important step in the healing process because the internal rotator muscles of the shoulder need to be stretched (mainly the pecs) in order to stabilize the shoulder and improve the biomechanics to help prevent the problem from developing again.
Suffering from a pinched nerve? Calgary’s Alberta Back and Neck Rehab & Sports Injuries Clinic can help you find relief for your shoulder pain. Call today.