What is the treatment for shoulder tendinitis?

From the Guidelines

Treatment for shoulder tendinitis should prioritize a combination of rest, medication, physical therapy, and gradual return to activity, with the goal of reducing pain and inflammation while promoting healing and preventing recurrence. The most effective approach typically involves:

• Resting the affected shoulder by avoiding activities that cause pain, though complete immobilization is not recommended 1
• Taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily) for 1-2 weeks to reduce pain and inflammation 1
• Applying ice to the painful area for 15-20 minutes several times daily, especially after activity, to reduce pain and inflammation 1
• Engaging in physical therapy exercises that focus on gentle stretching and strengthening of the rotator cuff muscles, such as pendulum exercises, wall crawls, and resistance band work 1
• Gradually returning to normal activities while maintaining proper form to prevent recurrence
• Considering corticosteroid injections or, rarely, surgical intervention for persistent cases 1

It's essential to note that most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months with appropriate treatment 1. The condition results from inflammation of the tendons connecting muscles to bones in the shoulder, often due to repetitive overhead movements or age-related degeneration.

Key considerations in treatment include:

• Relative rest and reduced activity to prevent further damage and promote healing and pain relief 1
• Cryotherapy for acute relief of tendinopathy pain 1
• Eccentric strengthening to reverse degenerative changes 1
• NSAIDs for short-term pain relief, although they have no effect on long-term outcomes 1
• Topical NSAIDs as an alternative with potentially fewer systemic side effects 1
• Surgical evaluation for patients who have failed conservative treatment 1

From the FDA Drug Label

Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout Improvement in patients treated for rheumatoid arthritis was demonstrated by a reduction in joint swelling, a reduction in duration of morning stiffness, a reduction in disease activity as assessed by both the investigator and patient, and by increased mobility as demonstrated by a reduction in walking time In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartum episiotomy and uterine contraction pain and dysmenorrhea

The treatment for shoulder tendinitis may include naproxen, as it has been studied in patients with tendonitis and has shown to be effective in reducing joint pain and improving mobility 2.

• Naproxen may help reduce pain and inflammation associated with shoulder tendinitis.
• It is essential to follow the recommended dosage and consult a healthcare professional for proper diagnosis and treatment.

From the Research

Treatment Options for Shoulder Tendinitis

The treatment for shoulder tendinitis can be divided into conservative and surgical methods.

• Conservative treatment includes rest, physical therapy, nonsteroidal anti-inflammatory drugs, and subacromial infiltration with corticosteroids 3.
• Surgery is recommended when conservative treatment fails 3.

Physiotherapy Interventions

Physiotherapy interventions, such as exercise and mobilization, have been shown to be effective in the treatment of shoulder tendinitis.

• Exercise has been demonstrated to be effective in terms of short-term recovery in rotator cuff disease 4.
• Combining mobilization with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease 4.

Alternative Therapies

Alternative therapies, such as ultrasound and platelet-rich plasma (PRP) injections, have also been studied as potential treatments for shoulder tendinitis.

• Ultrasound therapy has been shown to help resolve calcifications of shorter disease duration 5.
• PRP injections have been reported to be effective in the treatment of calcific tendinitis of the shoulder, with one case report showing complete resolution of calcific tendinitis after PRP injection 6.
• However, a randomized controlled trial found that PRP injections were no more effective than placebo in improving quality of life, pain, disability, and shoulder range of motion in patients with chronic rotator cuff tendinopathy 7.

Treatment Recommendations

Based on the available evidence, the treatment for shoulder tendinitis should be individualized and may involve a combination of conservative and alternative therapies.

• Conservative treatment, including rest, physical therapy, and nonsteroidal anti-inflammatory drugs, should be tried first 3.
• Alternative therapies, such as ultrasound and PRP injections, may be considered for patients who do not respond to conservative treatment 5, 6.
• Surgery should be considered only when conservative treatment fails 3.