Current and future advances in practice: tendinopathies of the shoulder

Tendinopathies of the shoulder are a burdensome problem. Current treatments include exercise, physical therapies, corticosteroid injections and surgery. However, the clinical outcomes from randomized controlled trials evaluating the effectiveness of these interventions are largely unremarkable. Given the apparent lack of progress in improving clinical outcomes for patients, it is appropriate to consider other avenues. Research has identified a link between lifestyle-related modifiable risk factors, including smoking, overweight and physical inactivity, and the onset and persistence of tendinopathies of the shoulder. Further research is required to understand whether addressing these factors results in better clinical outcomes for patients. Teachable moments and shared decision-making are concepts that could enable clinicians to integrate the assessment and management of these lifestyle factors. Given that these lifestyle factors also increase the risk of developing other common morbidities, including cardiovascular disease, an evolution of routine clinical care in this way could represent an important step forwards. Lay Summary What does this mean for patients? Disorders of the muscles and tendons of the shoulder are common and can be very painful. Treatments include exercise, injections and surgery. But many people with this condition do not respond well to those treatments and complain of ongoing shoulder pain and disability. More recent research has identified links between lifestyle, including smoking, being overweight and not moving enough, and painful disorders of the muscles and tendons of the shoulder. When people complain of painful disorders of the muscles and tendons, it might be helpful to consider these lifestyle factors rather than focusing on the muscles and tendons themselves.