From the Guidelines
The initial treatment for an adult with shoulder tendinitis should include relative rest, reduced activity, and cryotherapy, such as applying ice to the affected area for 10-15 minutes, several times a day, as these measures can help prevent further damage, promote healing, and provide pain relief. When considering treatment options, it is essential to note that the terms "tendonitis" and "tendinopathy" are often used interchangeably, but most patients seen in primary care will have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy" 1. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for short-term pain relief, but they have no effect on long-term outcomes, and their use should be limited to 1-2 weeks 1. Some key points to consider in the treatment of shoulder tendinitis include:
- Relative rest and reduced activity to prevent further damage and promote healing 1
- Cryotherapy, such as applying ice to the affected area, to provide acute relief of tendinopathy pain 1
- Eccentric strengthening exercises, which can be an effective treatment for tendinopathy and may reverse degenerative changes 1
- NSAIDs, such as ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily with food), for short-term pain relief 1
- Topical NSAIDs, which may have fewer systemic side effects, but their effectiveness compared to other analgesics is unclear 1
- Locally injected corticosteroids, which may be more effective than oral NSAIDs in acute-phase pain relief, but do not alter long-term outcomes 1 It is crucial to note that most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months with conservative treatment, and surgery should be reserved for patients who have failed conservative therapy 1.
From the Research
Initial Treatment for Shoulder Tendinitis in Adults
The initial treatment for an adult with shoulder tendinitis typically involves conservative management approaches.
- Rest and physical therapy are often recommended as the first line of treatment 2, 3, 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be prescribed to help manage pain and inflammation 2.
- In some cases, subacromial infiltration with corticosteroids may be considered as a later stage treatment option 2.
- Platelet-rich plasma (PRP) injections have also been explored as a potential treatment for shoulder tendinitis, with some studies suggesting they may be effective in improving pain and function 3, 5, 6.
- However, the current evidence on the use of PRP for shoulder tendinitis is inconclusive, and more research is needed to fully understand its effectiveness 6.
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for shoulder tendinitis, including:
- A study that found PRP injections to be more effective than corticosteroid injections and physical therapy in improving pain and function in patients with subacromial impingement syndrome 3.
- A study that found PRP injections to be more effective than an institution-based physical therapy program in improving shoulder pain and function in patients with adhesive capsulitis and diabetes mellitus 5.
- A case study that reported successful management of calcific tendinopathy using a conservative approach, including therapeutic exercise and rehabilitation 4.