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What is rotator cuff tendinopathy


Rotator cuff tendinopathy has many names. It is also called rotator cuff tendonitis and impingement syndrome.


The rotator cuff muscles help move the shoulder. They are important for overhead and reaching movements.


Rotator cuff pathology can be classified into three categories:

  • Tendonitis is acute inflammation of the tendon. This occurs after an injury or trauma.

  • Tendon tears can occur after severe injuries.

  • Tendinopathy is chronic overuse or overload of the tendon. This usually occurs after prolonged repetitive and overuse activities. Read more about tendinopathy here.


How does rotator cuff tendinopathy occur?


Rotator cuff tendonitis can occur after high impact activities that cause inflammation of the tendon. People with tendonitis can usually pinpoint a specific activity or injury that triggered the symptoms.


Rotator cuff tendinopathy results from repeated stress of the rotator cuff tendons. Pain usually gets worse over the course of days to weeks.


Rotator cuff tendinopathy symptoms


Rotator cuff tendinopathy causes pain around the shoulder. It can hurt to lift the shoulder up. Reaching and overhead motions may hurt. Lifting objects can be painful. Sporting activities that require overhead motions such as swimming, tennis, or throwing tend to aggravate symptoms. Occupational jobs that require repetitive motions such as construction or painting also aggravate symptoms.


Diagnosis of rotator cuff tendinopathy


Rotator cuff tendinopathy can be diagnosed with a thorough physical exam. Swelling of the shoulder may be present. Strength testing can provoke pain. Range of motion may be limited.


X-rays may be necessary in the setting of injury or trauma to rule out fracture.

Ultrasound can look for inflammation and assess the integrity of the tendon.


Rotator cuff tendinopathy treatment


Initial treatment involves resting and protecting the shoulder. Avoid or modify activities that exacerbate pain. Once pain improves, gradually increase physical activity.


Acute pain

  • Icing the area can help reduce pain and swelling. Apply ice 15-20 minutes at a time. Do this every 4 hours for the first two to three days or until pain improves.

  • Oral or topical anti-inflammatory medications can help decrease inflammation and control pain.


Supportive devices

  • A sling can be worn temporarily to provide support and comfort.


Persistent symptoms

  • Patients with persistent pain or symptoms may need injections.

  • Cortisone injections can help decrease pain and inflammation. This can reduce symptoms so that it is easier to perform effective rehabilitation.

  • Many studies have shown that platelet rich plasma injections can help those with rotator cuff tendinopathy.


Rotator cuff tendinopathy rehabilitation


The goal of rehabilitation is to return to activity as quickly and as safely as possible. Returning too soon can exacerbate symptoms. It can also weaken the tendon and lead to tendon tears.


A home exercise program will help improve range of motion, stability, and strength. Some people choose to participate in physical therapy. Physical therapists assess, guide, and teach you exercises and stretches. They also individualize a training program for you and your body.


Here is a link to a great example of a home exercise program for rotator cuff tendinopathy:

Rotator cuff tendinopathy stretches and exercises


Try to do your home exercise program twice a day. When pain is severe, focus on stretching and range of motion. Include strengthening exercises as pain improves.


Recovery for rotator cuff tendinopathy


Recovery is determined by the duration and severity of the injury. The longer you have symptoms, the longer it will take to get better. Use symptoms as a guide for progression. Avoid using time in days or weeks as a marker for recovery.


Decrease the frequency of your home exercise program as your symptoms improve. For example, if doing the exercises twice a day, decrease to once a day. Do this for about one week.


Many people choose to incorporate these exercises into their weekly workout routine. This can help prevent reinjury as well as maintain strength, mobility, and range of motion.


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Some pictures were taken without permission from the Sports Medicine Patient Advisor. They are intended for educational purposes only.