How Long Does Shoulder Tendonitis Last?

What is Shoulder Tendinitis?

Tendinitis, Tendinosis, Tendinopathy of the Shoulder: A Brief Vocabulary Lesson

In the medical and scientific fields, the following terms might be used:

• Tendinitis: When an inflammatory problem with the tendon is suspected.
• Tendinosis: When a non-inflammatory tendon problem is suspected.
• Tendinopathies: A general term for all types of tendon problems, including tendinitis and tendinosis.

Note: The key word here is “suspected.” As explained further below, no one really knows what exactly happens in a standard painful shoulder.

In essence, one could argue that saying:

“You have shoulder tendinitis” is equivalent to saying:
“You have a shoulder pain that is difficult to understand.” (!)

For simplicity’s sake and because the term “tendinitis” is widely used, I have chosen to use “shoulder tendinitis” throughout this article. However, as we will see, some shoulder pain specialists might not agree with this terminology!

Key Point: We talk about shoulder tendinitis when we think shoulder pain is caused by the inflammatory state of a shoulder tendon. The problem is that it’s far from certain this is the case! This is true even if an MRI or ultrasound suggests it.

MRI and Ultrasound: Unclear Utility

It’s not clear that MRI or ultrasound has a real benefit in understanding what’s happening in a painful shoulder. Shocking, right?

Generally, most people think as follows:

• If my shoulder hurts, there must be something inside causing the pain.
• If we can see what it is, it will help guide the choice of treatment.
• With an MRI or ultrasound, we will be able to see what’s happening.
• Therefore, I need an MRI or ultrasound.

Now, how would you reason if you learned this:

Many people who do not have shoulder pain have anatomical abnormalities visible on an MRI or ultrasound (like a tendon appearing inflamed, for example).

If this is true, then it means that MRI or ultrasound are not reliable for determining the source of your pain. To be 100% reliable for this purpose, an imaging technique should, for example:

• Show an inflamed-looking tendon when people are in pain.
• Never show an inflamed tendon when people are not in pain.

However, in some studies, anatomical abnormalities were found in nearly 100% of people with no shoulder pain. Among them, nearly 4 out of 10 had tendons that appeared inflamed (Girish, 2011; Lewis, 2016).

When Some Want to Ban the Expression “Shoulder Tendinitis”!

In the medical and scientific community, shoulder tendinitis is grouped with other problems into a broader category: shoulder pain related to the rotator cuff. (The rotator cuff is a group of deep shoulder muscles.)

In this category, we have:

• Tendinitis or tendinosis of the rotator cuff (our so-called shoulder tendinitis);
• Subacromial impingement syndrome;
• Pain suspected to be related to partial or complete rotator cuff tears.

For each subgroup, including tendinitis, the exact cause of the pain is uncertain. We have hypotheses but no certainties.

This is why researchers currently group and study these conditions together as if they were the same problem. This is also why these researchers encourage healthcare professionals to avoid using the term “tendinitis” with patients (Lewis, 2022).

When faced with a patient experiencing shoulder pain, specialists recommend referring to it simply as… Shoulder pain (related to the rotator cuff). That said, I will continue to use the term “tendinitis” in this article for the sake of simplicity, because it is commonly used, and because I emphasize its purely hypothetical nature.

You can, however, substitute it with the expression “poorly understood shoulder pain.“

Key Takeaway: World experts in shoulder pain think we should avoid telling someone with shoulder pain that they have shoulder tendinitis. Why? Because we’re not even sure it really exists!

What Do We Really Know About Shoulder Tendinitis?

As of 2023, specialists are still searching for answers. In other words, we are not quite sure what shoulder tendinitis really is today (Lo, 2022; Lo, 2023).

In theory, tendinitis is understood as inflammation of a tendon (or more precisely, a part of a tendon). But in practice, we don’t know:

• If among people with shoulder pain, all have inflamed tendons.
• If among those with shoulder pain AND an inflamed tendon:
• Whether the pain is truly due to the inflammation of the tendon.
• Assuming the above, whether this is the sole reason for the pain, or if there are other explanations.

For these reasons, stating “it’s tendinitis” in the face of shoulder pain is very speculative with our current knowledge.

Moreover, we are not certain that shoulder pain at its onset is explained in the same way as shoulder pain that has been present for several months. However, we do have some ideas, which I present in the following sections.

Recently Developed Shoulder Tendinitis

The scientific literature is clear on one point: almost all the information we have to date concerns chronic shoulder tendinitis, which has been present for a while.

Therefore, if you have shoulder pain that is:

• Very recent;
• Not stemming from a specific situation such as:
  • A fracture;
  • A cartilage injury (labrum tear);
  • A neurological injury;
  • A ligament injury following, for example, a shoulder dislocation;
  • A known rheumatic condition;
  • Recent surgery;
  • Frozen shoulder (adhesive capsulitis);
• And it’s possible to identify recent overuse of your shoulder,

then we do not have direct scientific information to explain what might be causing the pain.

However, we can make two reasonable assumptions:

1. Due to how you have been using your shoulder, you have likely damaged or disturbed something. “Damaged” or “disturbed” should be understood in a vague sense, without specific details about what and how (it might not be a tendon problem).
2. Since something has been damaged or disturbed, it will take some time for:

• The damaged part to heal;
• The disturbed part to settle.

Although these assumptions are quite vague, they can suffice to understand that at some point, relative rest will be necessary! I will return to this point later in the article.

Shoulder Tendinitis Persisting for Several Months

Our latest scientific knowledge points to the following explanation: shoulder tendinitis persisting for more than 3 months may be the result of a persistent multilocular inflammatory state.

Biological indicators of this inflammatory state have been found:

• In the blood (or more precisely, in the serum, a part of the blood).
• In certain tendons of the shoulder (so there is indeed a kind of “tendinitis,” but not only that!);
• In the subacromial bursa (a constitutive anatomical element of the shoulder);
• In the glenohumeral joint (the main joint of the shoulder);

However, it is important to emphasize that to date:

• This explanation still requires extensive scientific study to be fully trusted.
• We don’t really have an idea of how this inflammatory state would develop or why it would persist.

Key Points:

• In 2023, our scientific knowledge focuses almost exclusively on shoulder tendinitis persisting for several months.
• For recently occurring tendinitis, we can assume that the pain is due to something being damaged or disturbed. It’s worth noting that this something may not necessarily be a tendon.
• For tendinitis persisting for at least 3 months, research points to a persistent and multilocular inflammatory state. This explanation still requires further confirmation.

Sources : Lo, 2022 ; Lo, 2023

What Is the Healing Time for Shoulder Tendinitis?

I’ll begin with a general response applicable to all types of shoulder tendinitis. Then, I’ll delve into tendinitis that occurs recently.

General Response: The answer to the question of how long shoulder tendinitis lasts can be summarized in two points:

• For recently occurring tendinitis, expect 45 days to 3 months, especially if you’re under 55.
• For tendinitis present for more than 3 months, it’s common to expect at least an additional 6 months, especially if you’re over 55 (Tangrood, 2023).

It’s worth noting that only the second point is directly supported by scientific literature. What I mean by this is that there are specific studies that have attempted to evaluate the healing time of tendinitis lasting more than 3 months. This isn’t the case for recently occurring tendinitis.

How to Estimate the Duration of Recent Shoulder Tendinitis?

Some of you might wonder: How can we claim that recently occurring tendinitis will last between 45 days and 3 months without specific studies on the matter? Another legitimate question is: Why the age threshold of 55?

I’ll address these two questions in the following subsections.

Estimating the Duration of Recent Shoulder Tendinitis

To date, nobody truly knows what a recently occurring shoulder tendinitis might entail. Nobody knows precisely why it hurts. In fact, labeling it as “tendinitis” is somewhat misleading, as there’s no certainty that it involves a tendon issue.

Given these circumstances, how can we possibly estimate how long this so-called tendinitis will last? Let’s explore the theory first, followed by practical considerations.

In Theory:

Ideally, to determine the healing time of recent shoulder tendinitis, one would need to observe a group of individuals:

• experiencing recent shoulder pain resulting from intensive shoulder use;
• with known specific causes ruled out beforehand, potentially requiring tailored management (for this purpose, consulting a well-trained professional is strongly recommended).

Then, this group would be monitored until the pain subsides, and the average time to resolution would be calculated. However, to my knowledge, this type of study doesn’t exist for this type of pain. So, how can we practically gain insight into this matter?

In Practice:

In my opinion, it’s possible to make a reasonable estimation of the healing time for recently occurring shoulder tendinitis. This estimation relies on the following reasoning:

Although we don’t know exactly why it hurts, we can assume that something has been damaged or disrupted. There has been some form of injury, regardless of its nature. The shoulder has been overused.

In the case of a significant ligament injury, healing may take between 45 days and 3 months (excluding complete ruptures that may require surgery). Thus, at worst, we can assume that pain associated with this kind of injury can last up to a good 3 months.

So, at worst:

• if we imagine that your shoulder pain is related to an injury similar to a significant ligament injury,
• we obtain a healing duration of 45 days to 3 months.

Of course, this reasoning is based on a bundle of assumptions and uncertainties that need to be clarified:

• there’s absolutely no guarantee that recent shoulder pain stems from a ligament injury;
• our knowledge of ligament healing times pertains to ankle ligaments (Hubbard-Turner, 2008). It’s uncertain if the same applies to the shoulder.
• When a ligament is damaged, it’s uncertain if the pain is always related to the healing state of the affected ligament. The pain may subside or persist at some point, regardless of the healing process.

Nevertheless, in practice, counting on 45 days to 3 months provides a reasonable estimate in the absence of studies on the subject. From there, all we can do is hope for a quicker recovery!

Why Would Being Under 55 Favor Faster Healing?

There is evidence that being over 55 (on average) increases the risk of shoulder tendinitis becoming chronic (Struyf, 2016). In other words, being under 55 would favor faster healing.

This is plausible in my opinion because:

• all available scientific data to date on shoulder tendinitis generally involve individuals over 40 years old. One possible reason for this situation is that individuals under 40:
  • either are much less at risk of developing shoulder tendinitis;
  • or heal much faster, reducing their risk of ever being subjects in a scientific study on tendinitis!
• Generally, as one ages, the body unfortunately has more difficulty repairing any type of damage.

What Possible Causes for Persistent Shoulder Tendinitis?

The latest synthesis of scientific literature on this subject suggests:

that shoulder tendinitis persisting for more than 3 months could be caused by a multilocated inflammatory state;

that biological indicators of this inflammatory state have been detected: in certain shoulder tendons;

• in the subacromial bursa (an anatomical element of the shoulder);
• in the glenohumeral joint (the joint between the shoulder blade and the humerus);
• in the serum of the blood.

However, it should be noted that this explanation needs to be further studied to be truly confirmed. Also, we still do not know at this time how this inflammatory state would develop or why it would persist over time.

Sources: Lo, 2022; Lo, 2023

How to Shorten the Healing Time of Shoulder Tendinitis?

Is it really a good idea to want to heal quickly?

For recent shoulder tendinitis, wanting to heal quickly may not necessarily be a good idea. Indeed, in the short term, pain serves a genuine alarm function: it is there to signal to you that you need to calm down.

Our bodies cannot withstand all possible and imaginable physical constraints. While some are stronger than others, we all have our own limits. Your shoulder tendinitis indicates that you have overdone it compared to what your anatomy is capable of enduring.

The solution in these circumstances is to give your shoulder time to rest (relatively, of course, I’ll come back to this shortly). In the worst-case scenario, it will take between 45 days and 3 months for things to get back to normal.

Note: However, I am well aware that depending on people’s professional activities, resting is unfortunately not always possible…

When Living Well and Managing Pain Become the Main Issue

For shoulder tendinitis lasting more than 3 months, it is common to expect at least another 6 months to see improvements. And I wrote “at least” 6 months because:

• it can unfortunately take much longer;
• for many, “improvements” does not necessarily mean “recovery”.

In these circumstances, people learn to live with and manage their pain. The challenge from then on is to know:

• if it is possible to do this more or less effectively (in my opinion, it seems reasonable to think so);
• what are the best practices in this regard.

Keeping the Shoulder as Active as Possible: The Key in All Cases

The most recent scientific literature is clear: there is no miracle method to cure shoulder tendinitis. “Cure” should be understood here as permanently removing it. So that one can return to any physically demanding activity.

However, this same literature also suggests that keeping the shoulder as active as possible is the best way:

• to limit the risk of recent shoulder tendinitis becoming chronic;
• to best control pain and its consequences in cases of shoulder tendinitis lasting more than 3 months (Franco, 2019).

At this point, the attentive reader may have noted a contradiction with the first subsection of this section. For recent tendinitis, how can one keep the shoulder as active as possible when at the same time the pain indicates the need to rest?

This is indeed a challenge.

This is the kind of challenge that a physiotherapist, for example, can help you meet.

Revising Activity Demands: An Indirect Solution to the Problem

Imagine this. You’ve been practicing javelin throwing for several years. One day, you experience shoulder pain after a training session. The pain persists for a few days, even disturbing your sleep.

A few weeks later, you no longer feel any pain. You’ve resumed your normal life, except for javelin practice. You’ve replaced this activity time with badminton, which currently doesn’t cause you any pain.

Can we say you’re cured?

In a sense, yes, you no longer have pain for any of your daily activities. On the other hand, the pain might still be there if you were to resume javelin throwing. Maybe you’ve even tried again without success? In that case, one could just as easily say you’re not cured.

What does this little thought experiment teach us?

It teaches us that considering oneself cured or not of certain pains directly depends on the demands we have on our bodies:

• If you aspire to make it do difficult things: you risk being in pain everywhere, all the time.
• If you accept to adapt your activities according to your age, constitution, strengths, and weaknesses: everything goes much better!

Do you only have shoulder pain when you throw a javelin? After two hours of playing the accordion? When you want to swim 400m freestyle in less than 6 minutes?

What if you traded javelin for badminton? What if you were content with playing the accordion for only 1.5 hours? What if you accepted to swim your 400m a little slower?

Yes, I know things aren’t always that simple. But sometimes they are! In any case, deciding whether to replace or modify an activity is everyone’s business.

What Does Science Really Say About the Duration of Shoulder Tendonitis?

Science doesn’t directly address the overwhelming majority of shoulder tendonitis cases! How is this possible?

This is possible for two reasons:

1. 50 to 80% of people do not seek consultation for this type of problem and are therefore not studied. Indeed, all scientific studies focus on people who have consulted a healthcare professional for their tendonitis.
2. All studies mainly focus on people:

• who are over 40 years old;
• who have had pain for more than 3 months.

Therefore, we have no direct information on those under 40 and those with recent onset tendonitis.

That being said, may these points help you better assess the reliability of the information contained in this article.