Shoulder Tendinopathy

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Tendons are what connect your muscles to bones. If the tendons in your shoulder become injured, you may experience pain and it might be difficult to move. This is caused shoulder tendinopathy. There are two main causes of tendinopathy: 

  • Inflammation of the tendon which is called tendonitis and is less common
  • Tiny tears in the tendon, called tendinosis which is more common

Diagnosing Shoulder Tendinopathy at UVA Health

The doctor will ask about your symptoms and medical history. Then your provider will conduct a physical exam where they'll check: 

  • Tender areas
  • Range of motion
  • Muscle strength
  • Joint stability 

Your doctor may need to get detailed images of your shoulder. This may be done if the injury is severe or to rule out other problems. Images can be taken with:

  • MRI scan
  • Arthroscopy — a surgery that is done with a scope
  • X-rays
  • CT arthrography — specialized X-ray

Bursitis can cause similar pain symptoms. Your doctor may inject an anesthetic medication. If the pain goes away it may suggest bursitis not tendinopathy.

Treating Tendinopathy in the Shoulder at UVA Health

Tendinopathy and the associated pain may take months to resolve. It can be frustrating but it is important to follow through with recommended treatment. Treatments include:

Rest, Ice, Heat

Avoid activities that cause shoulder pain.

Use ice or an ice pack to help control pain and swelling. It may help during the first 24-48 hours after injury or after exercise. Protect your skin by placing a towel between the ice and your skin.

After a few days, heat may help decrease stiffness. Check with a doctor or therapist before using heat the first time. Protect your skin by placing a towel between the heat source and your skin.


The doctor may recommend medication to help reduce swelling and pain. Medication options include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain (e.g., aspirin or ibuprofen)
  • Topical pain medicines (eg, cream, patches) that are applied to the skin
  • Steroid injection into the bursa overlying the rotator cuff to decrease inflammation

Persistent or severe pain may need further treatment. Your doctor may inject a steroid into the area. It can temporarily relieve pain. However, frequent injections can damage the tendon.


Rehabilitation will help you regain strength and range of motion in your shoulder. It will also help you prevent future injuries. Rehabilitation may include:

  • Physical therapy to strengthen muscles that control the shoulder
  • Exercises to maintain normal range of motion
  • Exercises for specific muscles that are used in sports or job activities
  • Gradual return to sports and work
  • Learning how to modify activities to prevent re-injury


Severe injuries may require surgery to repair the tendon. The type of surgery will depend on the specific injuries.