From the Guidelines
Tendinosis of the shoulder should be treated with conservative measures, including relative rest, icing, and eccentric strengthening exercises, as these methods have been shown to promote healing and pain relief 1. The treatment of tendinosis of the shoulder typically begins with conservative measures, including:
- Relative rest from aggravating activities to prevent further damage and promote healing 1
- Icing for 15-20 minutes several times daily to provide acute relief of tendinopathy pain 1
- Over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) for pain relief, although these have no effect on long-term outcomes 1 Physical therapy is crucial, focusing on gentle stretching and progressive strengthening exercises performed 3-4 times weekly for 6-8 weeks, as eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1. For persistent pain, corticosteroid injections may provide temporary relief, though these are typically limited to 2-3 injections per year to prevent further tendon damage 1. More severe cases might require advanced treatments like platelet-rich plasma injections or surgical intervention if conservative management fails after 3-6 months. It's essential to note that tendinosis represents actual degeneration of tendon fibers due to repetitive microtrauma or aging, explaining why anti-inflammatory medications provide only partial relief 1. Recovery requires patience as tendon healing is slow due to limited blood supply, with improvement typically occurring over weeks to months rather than days.
From the Research
Tendinosis of the Shoulder
- Tendinosis is a clinical entity that affects many active people, and its treatment remains a challenge to sports medicine clinicians 2.
- The optimal nonoperative treatment of tendinosis is not clear, but eccentric exercise has the strongest evidence of efficacy 2.
- Other treatments such as extracorporal shock wave treatment, sclerosing injections, and platelet-rich plasma injections have shown promising results, but more clinical trials are needed to assess their efficacy 2, 3.
Treatment Options
- Eccentric exercise has been shown to be effective in reducing pain and improving function in patients with tendinosis 2.
- Corticosteroid injections have been shown to be effective in the short term, but may be worse than other treatments in the intermediate and long terms 4.
- Platelet-rich plasma injections have offered encouraging short-term results, but larger and longer-term clinical trials are needed to assess their efficacy 2, 3.
- Sodium hyaluronate injections have been shown to be effective in reducing pain and improving function in patients with lateral epicondylalgia 4.
Rotator Cuff Tendinopathy
- Rotator cuff tendinopathy is a common condition that can cause pain and weakness in the shoulder 5.
- A well-structured and graduated exercise program has been shown to be effective in improving symptoms and function in patients with rotator cuff tendinopathy 5.
- Education and lifestyle modifications, such as smoking cessation and stress management, may also enhance outcomes 5.
Effects of Anti-Inflammatory Treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but evidence for this treatment is lacking 6.
- A study found that short-term ibuprofen treatment had no effect on gene expression in human chronic tendinopathic tendon or led to any clear changes in tendon pain or function 6.