Many of the problems that occur around the shoulder involved long term damage to the surrounding tendons in the area. Tendons are connective tissue structures that attach muscle to bone and allow the muscles to exert their effect on the skeleton. Most tendon problems occur as a result of aging and normal use though acute injuries can certainly lead to further damage. The gradual degradation and age-related change in tendons is properly referred to as tendinosis. This term is often used interchangeably with tendinitis though the latter is considered less accurate as there is in fact little inflammation in the tendon material itself. The rotator cuff tendons and biceps tendon are both prone to tendinosis as patients approach middle age and can lead to symptoms of upper arm pain.