Shoulder Tendonitis
Shoulder tendonitis is inflammation of the tendons around the shoulder, often caused by overuse, repetitive overhead movements, or minor injury. It can lead to pain, stiffness, and difficulty lifting or rotating the arm, especially during activities like reaching, throwing, or lifting. Most cases improve with activity modification, physiotherapy, and anti-inflammatory treatments, though persistent symptoms may require targeted interventions.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
The Shoulder Joint
The shoulder is a complex joint supported by muscles and tendons that allow a wide range of motion. Tendons connect muscles to bone, helping the shoulder move smoothly.
Shoulder tendonitis occurs when one or more tendons - most commonly the rotator cuff tendons or the biceps tendon - become irritated or inflamed, usually from repetitive use, minor injury, or strain. This can cause pain, stiffness, and difficulty lifting or rotating the arm.
Commonly affected tendons include:
- Supraspinatus tendon – helps lift the arm.
- Infraspinatus tendon – rotates the arm outward.
- Subscapularis tendon – rotates the arm inward.
- Biceps tendon (long head) – helps lift and rotate the arm.
Tendonitis often develops gradually but can worsen if repetitive strain continues without rest or rehabilitation.
Understanding Shoulder Tendonitis
Shoulder tendonitis can affect daily activities and may develop gradually or after a specific strain. Symptoms often vary depending on which tendon is involved - the rotator cuff tendons (supraspinatus, infraspinatus, teres minor, subscapularis) or the long head of the biceps tendon - but typically include:
- Pain: Localised to the front, side, or top of the shoulder, often worse with lifting, reaching, or overhead movements.
- Tenderness: The affected tendon may be sore to touch.
- Stiffness or reduced range of motion: Difficulty performing normal activities, especially lifting the arm above the head.
- Night pain: Discomfort when lying on the affected shoulder is common.
- Activity-related flare-ups: Pain may ease with rest but return when using the shoulder, particularly in repetitive or forceful movements.
Causes & Risk Factors
Shoulder tendonitis develops when tendons in the shoulder become irritated or inflamed. Several factors can increase the risk:
| Repetitive overhead activities | Frequent lifting, throwing, or sports like swimming, tennis, or weightlifting can strain the shoulder tendons over time. |
| Age-related wear | Tendons naturally lose elasticity and strength with age, making them more susceptible to inflammation. |
| Poor posture or mechanics | Slouched posture, rounded shoulders, or abnormal shoulder movement patterns increase stress on tendons. Weak rotator cuff or scapular stabilising muscles can also alter shoulder mechanics and increase tendon load. |
| Previous shoulder injuries | Past dislocations, strains, or rotator cuff tears can weaken tendons and predispose to recurrent inflammation. |
Diagnosing Shoulder Tendonitis
Diagnosing shoulder tendonitis starts with a detailed clinical assessment, followed by imaging when needed to confirm the condition or evaluate severity.
During the clinical examination, The specialist will examine the shoulder for tenderness over the rotator cuff or biceps tendon, check pain with specific movements, assess range of motion and strength, and look for swelling or compensatory movement patterns.
| Ultrasound | First-line, non-invasive imaging that shows tendon thickening, inflammation, partial tears, or calcifications. It also allows dynamic assessment during movement. |
| MRI | Provides detailed views of the tendons, surrounding muscles, and bursa. Used when symptoms persist, ultrasound findings are unclear, or a structural tear is suspected. |
Accurate diagnosis ensures the correct treatment plan and helps distinguish tendonitis from other shoulder conditions such as bursitis or rotator cuff tears.
Treatment Options
Shoulder tendonitis is usually managed with a combination of conservative measures and, in selected cases, procedural interventions. Treatment aims to reduce pain, decrease inflammation, and restore normal shoulder function.
Conservative Treatments
| Rest and activity modification | Avoid movements that aggravate the shoulder, especially overhead or repetitive actions. |
| Physiotherapy | Targeted exercises to strengthen the rotator cuff and biceps tendons, improve shoulder mechanics, and restore range of motion. |
| Medications | Over-the-counter painkillers or anti-inflammatory medications can help manage discomfort. |
| Steroid injection | Short-term use of non-steroidal anti-inflammatory druds (NSAIDs) such as ibuprofen can help reduce pain and swelling. |
Procedural Options
| Steroid injection | Deliver anti-inflammatory medication precisely around the irritated tendon or bursa, offering targeted pain relief and reducing swelling. Often used when pain limits rehabilitation progress. |
| PRP (platelet-rich plasma) injections | Concentrated platelets from the patient’s own blood are injected around the damaged tendon to promote healing and tissue repair. Typically considered for chronic tendonitis that has not improved with physiotherapy. |
| Surgery | Reserved for cases where symptoms persist despite comprehensive conservative and injection therapy. Procedures may include debridement of damaged tendon tissue, removal of calcific deposits, or addressing associated structural issues such as impingement. |
How can Lanthorn help?
Shoulder Ultrasound - £300
Lanthorn provides high-resolution shoulder ultrasound as a first-line assessment to identify tendon inflammation, tears, calcification, or bursal swelling. This dynamic scan allows real-time evaluation during movement, helping pinpoint the exact source of pain and guiding personalised treatment.
MRI Shoulder - From £350
For more complex or persistent cases, Lanthorn offers MRI to provide a detailed view of the rotator cuff tendons, biceps tendon, bursa, and surrounding structures. MRI helps detect subtle tears, impingement, or degenerative changes that may not be visible on ultrasound, supporting precise diagnosis and treatment planning.
Ultrasound-guided Steroid Injection - £450
Targeted steroid injections delivered precisely to the inflamed tendon sheath or bursa under real-time ultrasound guidance. The steroid works by reducing local inflammation, easing swelling, and calming irritated tissue, which in turn helps relieve pain and improve mobility.
PRP Injection - From £750
Ultrasound-guided PRP injections for patients with chronic tendonitis that has not improved with conservative care. The procedure delivers the patient’s own platelet-rich plasma directly to the inflamed tendon, supporting tissue healing and helping restore long-term function.
