What treatment options are available for mild bicipital tenosynovitis, calcific tendinopathy of the subscapularis, and tendinopathy of the supraspinatus?

How to Explain Your Shoulder Ultrasound Results

Your ultrasound shows three mild problems in your shoulder that are causing inflammation and wear-and-tear changes in the tendons, but the good news is that none of your tendons are torn and these conditions typically respond well to conservative treatment without surgery. 1

What Each Finding Means

Mild bicipital tenosynovitis:

• The biceps tendon runs through a groove in the front of your shoulder, and the sheath surrounding this tendon has become inflamed and irritated 2
• This causes pain in the front of your shoulder, especially with overhead activities or lifting 3

Mild calcific tendinopathy of the subscapularis:

• The subscapularis is one of your rotator cuff muscles in the front of your shoulder, and small calcium deposits have formed within this tendon 4, 5
• This represents a degenerative process where the tendon has developed these deposits, which can cause pain and stiffness 2
• While calcific tendinopathy affects up to 20% of painful shoulders, it occurring in the subscapularis specifically is less common than in other rotator cuff tendons 3, 6

Mild tendinopathy of the supraspinatus:

• The supraspinatus is the rotator cuff muscle on top of your shoulder that helps you lift your arm 2
• This tendon shows degenerative changes from repetitive use rather than acute inflammation, which is why we call it "tendinopathy" instead of "tendinitis" 2, 7

The positive findings:

• No tears in any of your rotator cuff tendons—they are all intact 1
• No fluid buildup in the joint or bursa 2
• No impingement (pinching) of the tendons 2

What This Means for Your Recovery

Approximately 80% of patients with these types of tendon problems fully recover within 3-6 months with conservative treatment, meaning you likely won't need surgery. 7

Your Treatment Plan

Initial phase (first 4-6 weeks): 1

• Relative rest: Reduce activities that aggravate your symptoms, but don't completely stop moving your shoulder to prevent stiffness and muscle loss 2, 1
• Ice therapy: Apply ice through a wet towel for 10-minute periods after activities or when pain flares to reduce pain and swelling 2, 1
• Pain medication: Short-term use of anti-inflammatory medications (like ibuprofen or naproxen) for pain relief, or topical versions if you have stomach sensitivity 2, 1

Physical therapy phase (6-8 weeks if needed): 1

• Gentle range of motion exercises initially, progressing to strengthening exercises 1
• Eccentric exercises (controlled lengthening of the muscle) have proven particularly beneficial for tendon problems and may help reverse the degenerative changes 2, 1
• Learning how to modify daily activities to reduce pain and prevent further irritation 1

If conservative treatment isn't enough: 1

• Corticosteroid injections may provide temporary pain relief, particularly for the biceps inflammation 1, 3
• However, injections should be used cautiously as they may weaken tendons if injected directly into the tendon substance 2

Surgery is rarely needed and would only be considered if symptoms remain debilitating after 3-6 months of conservative care 1, 8

What to Expect

• Your symptoms should gradually improve over the next several months with appropriate treatment 7
• Pain may initially worsen with activity but should subside as you warm up in the early stages 7
• You'll be reassessed every 2-4 weeks to monitor progress and adjust your treatment plan 1

Important Caveats

• Avoid complete immobilization of your shoulder, as this leads to stiffness and muscle wasting 2
• Continue activities that don't worsen your pain 2
• Be patient—tendon healing takes time, and rushing back to full activity can prolong recovery 7