The term “tennis shoulder” may suggest an injury limited to professional athletes or tennis players, but the reality is far broader. Shoulder injuries caused by repetitive strain and overuse can affect virtually anyone—from office workers and manual labourers to healthcare professionals and individuals performing routine daily activities. Today, the term is widely used to describe a range of overuse shoulder injuries that develop as a result of repetitive movements and prolonged physical stress rather than sporting activity alone.
Shoulder pain is among the most common musculoskeletal complaints and one of the leading reasons for visits to orthopaedic and physiotherapy clinics. The risk increases with age, as well as with occupations or activities that involve repeated lifting, carrying heavy loads, or prolonged movements above shoulder level.
Why the Shoulder Is Vulnerable
The shoulder is the most mobile joint in the human body, allowing the arm to move through an exceptionally wide range of motion and perform both powerful and highly precise movements. However, this remarkable flexibility comes at the expense of stability. Unlike many other joints, the shoulder depends heavily on its surrounding muscles, tendons and ligaments to maintain strength and control during movement.
At the centre of this support system is the rotator cuff—a group of muscles and tendons responsible for stabilising the shoulder joint, lifting the arm and enabling controlled rotation. Repeated strain or excessive use can irritate these tendons, causing inflammation that may gradually progress to partial or even complete tears if left untreated.
Common overuse shoulder injuries include rotator cuff tendinitis, shoulder impingement syndrome and biceps tendon inflammation. Although frequently associated with tennis players, swimmers and other overhead athletes, these conditions can develop in anyone whose work or daily activities involve repetitive arm movements. Ignoring early symptoms while continuing the same activities often allows the injury to worsen, leading to persistent pain, weakness and reduced shoulder function.
Who Is Most at Risk?
Although commonly linked to sport, repetitive shoulder injuries affect a wide range of people, including:
Tennis, swimming, volleyball and handball players.
Construction workers, painters, electricians and carpenters.
Nurses and healthcare workers who regularly lift or reposition patients.
Warehouse employees and workers who frequently handle heavy loads.
Individuals who suddenly return to exercise after long periods of inactivity.
Older adults, whose tendons naturally become less resilient with age.
Several additional factors can further increase the risk of injury, including weak shoulder muscles, poor posture, inadequate warm-up before exercise and incorrect movement techniques.
Recognising the Symptoms
Shoulder overuse injuries often begin with mild discomfort that appears after physical activity and disappears after a short period, prompting many people to ignore the warning signs. Over time, however, the pain becomes more frequent and may even occur at rest.
Common symptoms include:
Pain at the front or side of the shoulder.
Increased pain when lifting the arm above shoulder level.
Difficulty dressing or combing hair.
Pain that disrupts sleep, particularly when lying on the affected shoulder.
Weakness when lifting or carrying objects.
Reduced range of shoulder movement.
Occasionally, a grinding or clicking sensation during movement.
In more advanced cases, even raising the arm can become extremely difficult, making simple everyday tasks challenging.
Diagnosis
Diagnosis begins with a detailed medical history, including the patient’s occupation, sporting activities and the nature of their symptoms. This is followed by a clinical examination to assess shoulder mobility, muscle strength and a series of specialised tests that help identify the source of the injury.
Imaging studies may also be required. X-rays are commonly used to rule out fractures or underlying bone abnormalities, while magnetic resonance imaging (MRI) provides the most accurate assessment of the rotator cuff, revealing inflammation, tendon degeneration or tears. In some cases, ultrasound imaging may also be used to evaluate tendon movement dynamically during shoulder motion.
Prevention and Treatment
Most overuse shoulder injuries can be prevented through simple but effective measures. These include warming up before exercise, strengthening the shoulder and upper back muscles, using proper technique during physical activity, increasing training intensity gradually, taking regular breaks during repetitive work and maintaining good posture while sitting or working. Most importantly, early shoulder pain should never be ignored, as it is often the body’s first warning that intervention is needed.
Treatment depends on the severity of the injury, although the majority of patients recover successfully through conservative management without requiring surgery.
The initial approach usually involves reducing activities that aggravate symptoms, particularly repetitive overhead movements. Cold compresses are recommended during the first few days to reduce inflammation, followed later by warm compresses to help relax surrounding muscles. Doctors may also prescribe non-steroidal anti-inflammatory medications for a limited period, depending on the patient’s overall health.
Physiotherapy remains the cornerstone of recovery. Treatment focuses on restoring shoulder mobility, strengthening the rotator cuff and shoulder blade muscles, correcting movement patterns and improving muscular balance. These measures not only promote healing but also significantly reduce the likelihood of future injury.
When conservative treatment fails to provide sufficient improvement, local corticosteroid injections may be considered. Surgery is generally reserved for patients with significant tendon tears, substantial loss of shoulder function or persistent pain and disability despite several months of appropriate treatment.
Conclusion
Shoulder pain often begins as a minor annoyance that seems easy to dismiss. Yet delaying treatment can allow a manageable condition to develop into a chronic problem that affects quality of life, work performance and participation in sport.
Early diagnosis, adherence to an appropriate treatment programme and adopting healthy preventive habits remain the most effective ways to protect this highly mobile and essential joint, helping individuals maintain pain-free movement and long-term shoulder function.
By: Dr Badreyya Al-Harmi, Public Health Consultant
