What Is Rotator Cuff Tendonitis?
The rotator cuff is an arrangement of muscles and tendons that holds the head of the upper arm bone within the shoulder socket. Rotator cuff tendinitis is the resulting condition when these muscles and tendons become inflamed or damaged .
The dominant symptom is a nagging, aching pain in the upper arm and shoulder that gets worse when raising the arms or reaching backward. You may also experience shoulder swelling and have difficulty lifting or rotating your arm.
Early treatments include resting the affected shoulder, applying ice, and taking over-the-counter pain medication. Stretching and cortisone injections may be recommended by your medical provider. In cases where tissue damage or bone spurs are present, surgery and follow-up exercises may be needed in order to have a full recovery.
You should visit your primary care physician who will coordinate care with a muscle and bone specialist (orthopedic surgeon). Treatments for impingement syndrome involve rest, over-the-counter pain medication, steroid injections, physical therapy, and surgery in rare, serious cases.
How common is Rotator Cuff Tendonitis?
Symptoms that always occur with Rotator Cuff Tendonitis:
- Pain in one shoulder
Rotator Cuff Tendonitis is also known as
- Rotator cuff injury
- Shoulder impingement
- Shoulder bursitis
- Biceps tendinitis
- Pitcher's shoulder
- Tennis shoulder
- Swimmer's shoulder
- Shoulder overuse syndrome
Rotator Cuff Tendonitis Symptoms
Symptoms primarily include shoulder pain, weakness, and limited range of motion.
If you have rotator cuff tendinitis, you may experience shoulder pain, described as:
- A dull ache: This will be felt deep in the shoulder, typically felt more toward the front, but it may be hard to pinpoint the exact location of the pain.
- Constant: Shoulder pain is typically present during both activity and rest.
- When the arm is lifted: Pain will usually be at its worst when the arm is lifted 60 to 120 degrees.
- Worse when lying on the affected shoulder
Weakness and limited range of motion
This may cause:
- Swelling of the shoulder
- Difficulty lifting the arm: You may have trouble brushing your hair or putting on a shirt.
- Difficulty rotating the arm: You may be unable to scratch your back.
Rotator Cuff Tendonitis Causes
The rotator cuff is a group of muscles and tendons that surround the shoulder joint and serve to keep the upper arm bone (humerus) in its socket and to enable movements of the upper arm, such as rotating and lifting overhead . It includes the supraspinatus, infraspinatus, teres minor, and subscapularis (SITS) muscles. The shoulder consists of a variety of structures in a tight space, so injury to one structure can lead to irritation of surrounding structures. Tendinitis is inflammation of a tendon. It is mainly caused by wear-and-tear, but can also be caused or exacerbated by an injury.
Injury and wear-and-tear
Although a single injury, such as from a fall or overstretching, can lead to a tear in the rotator cuff, most rotator cuff injuries result from chronic use . With wear-and-tear, the rotator cuff tendons can become injured and inflamed, leading to pain, weakness, and decreased mobility of the arm.
- Pinched tendon: The supraspinatus tendon can become pinched between two bones in the shoulder (humeral head and coracoacromial arch), leading to tendinitis.
- Use after an injury: The supraspinatus has a fragile region (with a limited blood supply), so inflammation from minor injuries can lead to further damage, such as tears of the rotator cuff, especially with continued use following an injury.
- Subsequent bursitis: Tendinitis can also lead to swelling and scarring of the tissue around the rotator cuff (bursitis).
Who is most likely to be affected
People most commonly affected by rotator cuff tendinitis include:
- Those who engage in repetitive arm-elevating motions: Including construction workers, painters, cleaners, hair stylists, and grounds keepers
- Athletes: Those who engage in repetitive overhead arm movements, such as baseball pitchers, weightlifters, football players, swimmers, and tennis players
- Those older than 40 years: However, rotator cuff injuries can occur at any age
Treatment Options and Prevention
Most people experience improvement from rotator cuff injuries, following rest from aggravating activities, careful exercises, and self-care. Treatments can be divided into initial and secondary categories, as well as surgical treatments and rehabilitation for more severe cases.
Many minor injuries heal on their own and require only minor supportive interventions .
- Rest: If pain is severe, the arm can be held in a sling for a few days. It is best to avoid strenuous activity or painful movements until the pain from the injury has begun to improve, to avoid further injury. However, it is advisable to resume slow, controlled movements that cause minimal pain as soon as possible, to prevent the shoulder from becoming stiff.
- Ice: Place ice packs on the painful area for 15 to 30 minutes, three to five times per day, to reduce inflammation and relieve pain.
- Pain relievers: Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve), can temporarily reduce the pain associated with rotator cuff tendinitis.
If pain does not respond to supportive treatments at home, your physician may recommend more intensive treatments.
- Physical therapy: Therapy can be helpful at all stages of recovery from shoulder injury. Your therapist will help you regain strength and flexibility, so you can safely return to activities of daily life.
- Joint injections: If several weeks of conservative treatment have passed and pain persists, your physician may offer a steroid injection. In this office-based procedure, a needle is inserted into the joint space and medication is injected to relieve pain and reduce inflammation.
Surgical treatments for severe cases
In cases of severe damage to the rotator cuff, or when pain persists despite months of more conservative treatments, orthopedic surgery and physical rehabilitation may be recommended . Various surgical methods include:
- Subacromial decompression (acromioplasty): Using a small camera and tools, a surgeon can shave excess bone from the joint to create more space for the rotator cuff and prevent impingement.
- Arthroscopic tendon repair: In this procedure, a tiny camera and tools are inserted into the joint through small incisions and used to repair the torn tendon.
- Open tendon repair: Repairing more severe tears may necessitate a more invasive version of arthroscopic tendon repair, requiring a larger incision and often resulting in a more painful recovery.
- Tendon transfer: Tendons from other parts of the body can be transferred into the shoulder to replace severely damaged rotator cuff tendons.
- Shoulder replacement (shoulder arthroplasty): Severely injured joints can be addressed by installation of artificial joint components, made of metal or ceramic.
In order to reach a good outcome from shoulder surgery, you must work closely with your surgeon and physical therapist. Your physical therapist will prescribe exercises  to gradually regain strength in the shoulder, likely over several months. Exercises can also be used to prevent rotator cuff tendinitis:
- Daily stretches: Tohelp prevent tissues from becoming tight.
- Strengthening exercises: These will help optimize balance in the shoulder joint.
Healing may take several months and may necessitate long-term reduction in certain activities. Without proper treatment, rotator cuff injuries may cause long-term problems, such as:
- Permanent loss of motion
- Permanent weakness
- Degeneration of the shoulder joint
- Frozen shoulder: This is where the tissue surrounding the shoulder joint becomes thickened and tight, making it difficult to move the arm.
When to Seek Further Consultation
You should seek medical attention with any significant injury to the shoulder, if you cannot move your shoulder, or if you are requiring persistent pain medication.
If you have injured your arm and experience symptoms
The shoulder is a complex joint that can be injured in several ways. If you have injured your shoulder and experience symptoms, such as pain or weakness, contact your primary care physician for a full evaluation and treatment plan.
If you cannot move your shoulder
Inability to move the shoulder may be a sign of a tear or other serious injury and should be evaluated as soon as possible.
If you are requiring pain medication multiple times each day
You should contact your physician about additional treatment options.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Can you fully move your shoulders around?
- How severe is your shoulder pain?
- Is your shoulder pain getting better or worse?
- How long has your shoulder pain been going on?
- How would you explain the cause of your shoulder pain?
The above questions are also covered by our A.I. Health Assistant.
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- What To Do About Rotator Cuff Tendinitis. Harvard Medical School: Harvard Health Publishing. Published July 2007. Harvard Health Publishing Link
- Ma CB, Zieve D, Conaway B, et al. Rotator Cuff Problems. U.S. National Library of Medicine: MedlinePlus.Published September 7, 2017. MedlinePlus Link
- Rotator Cuff Tendonitis. Cleveland Clinic. Cleveland Clinic Link
- Rotator Cuff and Shoulder Rehabilitation Exercises. American Academy of Orthopaedic Surgeons: OrthoInfo. Published October 2012. OrthoInfo Link