Shoulder Tendinitis, Bursitis, and Impingement Syndrome

The Root of Most Shoulder Pain

Woman in pain
Credit: Bruce Laurence/Photographer's Choice/Getty Images

The shoulder is a complex structure. Because it is so complex, it is a place where many things can go wrong. Learn about the three most common sources of shoulder pain and how to get relief.

Understanding Your Shoulder

The shoulder is made up of three bones: the humerus (upper arm one), the scapula (shoulder blade) and the clavicle (collarbone). It's also home to the rotator cuff, which includes the muscles and tendons that attach the upper arm bone to the shoulder blade. A bursa, which is a small, fluid-filled sac, lies between the rotator cuff and the acromion, or the bone on top of the shoulder blade. The bursa allows the rotator cuff to move more smoothly during arm movement by reducing friction and providing cushioning.

Sources of Shoulder Pain

With so many different structures and functions, it's no wonder that shoulder pain is one of the most common complaints. Any kind of pain in the shoulder can typically be linked to:

  • Tendinitis: Shoulder tendinitis occurs when tendons in the rotator cuff become inflamed and irritated. This pain is often a result of being pinched by surrounding structures. Shoulder tendinitis pain ranges from mild to severe.
  • Impingement:  The amount of space between the acromion (the top of the shoulder blade) and the rotator cuff narrows, causing the acromion to rub against or "impinge" on the tendon and bursa, causing pain. This squeezing of the rotator cuff muscles is known as shoulder impingement syndrome and also as swimmer's shoulder.
  • Bursitis: Tendinitis and impingement syndrome are often accompanied by shoulder bursitis, which occurs when cushioning, friction-reducing bursae become inflamed.

When muscles, tendons, and/or bursae experience an injury, they become inflamed and swollen. Because space is so limited within the shoulder joint, the swelling forces the muscles and tendons to squeeze between the bones in the shoulder joint: the humerus and the acromion. Wear and tear build up over time and can irritate the tendons, muscles, and surrounding tissue.

Symptoms of Shoulder and Rotator Cuff Conditions

Shoulder pain can stem from an injury or occur seemingly out of nowhere. This condition is most prevalent among young athletes and the middle-aged. In general, it is related to any type of repetitive lifting or overhead activities that involve the arm, such as playing baseball or tennis, working in construction, painting, swimming, etc.

Symptoms of a shoulder injury include the following:

  • Slow onset of pain in the shoulder and upper arm area
  • Pain, swelling, and tenderness in the shoulder (rotator cuff pain is generally located in the front of the shoulder)
  • Pain and stiffness when raising and lowering the arm
  • Pain during both periods of activity and rest
  • Difficulty sleeping on the shoulder

Diagnosis and Treatment of Shoulder Injuries

Tendinitis, bursitis, and impingement can be diagnosed with a physical exam and a patient's medical history. A doctor may also use an imaging test, such as an MRI exam, to confirm a diagnosis.

Treatment for these kinds of injuries varies. In many cases, doctors prescribe rest, ice, and anti-inflammatory medication. Your doctor may recommend physical therapy or start you on an at-home gentle stretching and strengthening exercise program to relieve pain and improve range of motion. If rest and medication are of little use, a steroid injection can also help relieve pain.

If there is no sign of improvement after six to 12 months, surgery may be the next step. Arthroscopic surgery and open surgery are used to repair shoulder damage. Your doctor will provide a rehabilitation and physical therapy program based on your specific needs. It usually takes approximately two to four months to be completely pain-free after shoulder surgery, but for some, it can take up to a year.

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