Off The Cuff

Shoulder tendinopathy can not only affect athletics but also daily life

Pain when you make a serve in tennis. Pain when you reach for a dish to serve dinner. The culprit could be the same.

Shoulder pain has several possible causes, but one of the most common is shoulder tendinopathy. When tendons in the shoulder are inflamed or have small tears, the pain can be sharp when a person reaches overhead. This is why the condition is sometimes referred to as “tennis shoulder.” In some cases, it can be painful enough to keep you from reaching up for any reason—swimming, golf, or just living life.

“With the shoulder, it can be any activity,” says orthopedic surgeon Thomas Alexander, MD. “When you elevate your shoulder over 90 degrees, that requires your rotator cuff, which is a group of muscles and tendons surrounding the shoulder joint. Inflammation or tears in the rotator cuff is one of the most common things I treat.”

The biceps tendon, which runs underneath the rotator cuff, can also cause pain if it is damaged. Even within shoulder tendinopathy, the causes can be multi-factorial. But it often involves a person’s age.

What The Tendons Tend To Do

“Shoulder tendinopathy can happen at any age,” Alexander says. “However, we do know that as each decade passes, tendons in the rotator cuff tend to become more degenerative. So it’s more prone to injury.”

For patients in their 20’s and 30’s, the cause is usually as single traumatic event, such as falling on outstretched arms. But the incidence of pathology, whether of inflammation, partial tear, or complete tear, increases with age.

“Being older doesn’t guarantee that you will have a problem, it just makes it more likely,” Alexander says. “Particularly if you are active. But it doesn’t have to be overuse from athletics. Your pain could come from cleaning the house as much as it might come from playing tennis.”

Rest And Rehabilitation

“If the problem is inflammation, you should be able to reverse the problem with prescription, and in some cases over-the-counter, medication,” Alexander says. “Some patients may need a steroid injection, which also works as an anti-inflammatory.”

A specially-designed exercise program, either through physical therapy or a program done at home, can also help re-strengthen the muscles in the rotator cuff and reduce inflammation.

The hardest part for the patient, though, may be doing nothing. That is, avoiding activities that cause pain. This period generally lasts about six weeks.

“These interventions will work for about two-thirds of our patients, and then they can go back to their regular routine,” Alexander says.

A Tear Takes Time

For patients whose pain is more severe or doesn’t alleviate, an MRI is needed to spot a probable rotator cuff tear. If Dr. Alexander sees a full-thickness tear, meaning the tendon is completely torn off of the bone, he will have to repair the problem surgically.

In most cases, Dr. Alexander can do the repair arthroscopically, meaning that he will insert a tiny camera into the joint and use the images to guide his surgical instruments. This is a minimally-invasive surgery that only requires small incisions, and is usually an outpatient procedure from which the patient returns home on the same day.

Recovery after surgery, however, is a different matter. The surgical repair allows the reattached tendon to heal, but only time can ensure this happens.

“That’s just the biology of the condition,” Alexander says. “Once we’ve created the environment for your body to heal, it still takes time. Usually about 12 weeks.”

Dr. Alexander knows that sitting on the sidelines—whether on the court or in life in general—for four months is not easy. But the payoff for patience is getting your life back.

“Throughout the recovery process, the body will heal and we’ll help you regain strength there,” Alexander says. “Generally, we can get people back to the life they enjoyed.”

Tennis what?

Another common phrase you hear on the courts is tennis elbow. Like tennis shoulder, pain is caused in the area by damaged tendons, usually due to overuse or repetitive strain. Its real name is lateral epicondylitis, and it shares some treatment options with tennis shoulder, such as physical therapy. Dr. Alexander also performs surgical repair for severe cases of tennis elbow.