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Abstract
Background: Shoulder tendinopathy is a common condition in physical therapy, and the term tendinopathy covers a broad spectrum of pathology. Additionally, there is a lack of consensus on proper terminology for shoulder disorders. Nomenclature for shoulder disorders includes such terms as impingement, tendinitis, tendinosis, and tendinopathy. The continuum of physiologic changes with tendinopathy, as well as the various causes of tendinopathy are complex and require a detailed physical examination to discover the source of pain and extent of pathology to determine appropriate course of treatment.
Objectives: The purpose of this review is three fold. First, the physiology of shoulder tendinopathy will be discussed. Second, the various mechanisms for shoulder tendinopathy will be explored. Finally, a review of the proposed interventions for shoulder tendinopathy will be highlighted, citing the best available evidence for each intervention.
Major findings: Both the causes and the physiology of shoulder tendinopathy require a multi-faceted approach to maximize outcomes. There is a paucity of data supporting modalities in the management of shoulder tendinopathy, but high-energy extracorporeal shock wave therapy has shown some effectiveness in calcifying tendinitis. Therapeutic exercise is generally accepted as a beneficial intervention, but definitive conclusions cannot be made at this time. Furthermore, eccentric training for management of tendinopathies in general is gaining more support in the literature, but evidence for its utilization in shoulder tendinopathy is scarce.
Conclusions: A host of causes and physiologic changes exist for shoulder tendinopathy, in addition to multiple treatment options. However, no definitive conclusions can be made regarding the best treatment for shoulder tendinopathy. Current evidence is largely anecdotal and speculative. More randomized, controlled trials are needed that compare modalities, manual therapy, and therapeutic exercise.