Feeling pain in your shoulder that just won’t go away? It could be rotator cuff tendinitis, says Terrance Sgroi, DPT, SCS, doctor of physical therapy and sports clinical specialist. The rotator cuff is a group of muscles and tendons that attach on the outside of the shoulder, providing joint stability and enable the shoulder to rotate. Rotator cuff tendonitis occurs when one of these tendons is irritated and inflamed. The causes are the usual suspects—general wear and tear, overuse or repetitive strain, or a sports injury.
Rotator cuff tendinitis is particularly common among people who use their shoulder muscles to move their arms overhead for long periods—swimmers, golfers, and baseball and basketball players as well as construction workers and house painters. But it can also happen for less obvious reasons, such as sitting at a desk with rounded shoulders and, simply, advancing age—as we get older, tendons are more susceptible to degenerative changes that may lead to tendinitis. And recently, we’ve seen that playing pickleball can tip the scale toward rotator cuff inflammation, especially when age and lifestyle habits have set the groundwork.
Not surprisingly, the number-one symptom of rotator cuff tendinitis is rotator cuff pain, typically in the upper and outer parts of the shoulder, usually in the area where the deltoid muscle is located. Pain sometimes can travel down to the middle of the arm but is unlikely to go below the elbow. Many people also experience muscle weakness and limited range of motion—you might be able to raise your arm only a certain amount before you feel pain.
Many sufferers try to work through the pain of rotator cuff tendinitis on their own or turn to the Internet for help. But that may increase the inflammation and cause a problem that could have been managed with conservative treatment to become one that might require more aggressive treatment such as surgery to repair a ruptured tendon.
Important: You may be able to get some shoulder pain relief from minor rotator cuff tendinitis simply by resting, avoiding irritating activities and taking an over-the-counter anti-inflammatory such as ibuprofen, and then only gradually resuming the activities you love. But tendinitis won’t be a one-and-done problem if you don’t correct the body mechanics that caused it in the first place as well as properly build up your shoulder muscles, giving your body the support it needs. This is why getting advice from a physical therapist (PT) helps.
When people want to understand an injury, they often ask Google, AI and then a PT, in that order. Better: Start with a PT. He/she can find the root cause of your rotator cuff tendinitis, work to eliminate your pain and restore your range of motion, often with stretching exercises or other manual therapies and modalities such as laser, heat and/or ice. When pain does not respond to these treatments, the next step might be injections of cortisone or platelet-rich plasma from a physician who specializes in shoulders.
Rotator cuff exercises begin gradually, starting first with arms kept below shoulder height, then with arms above shoulder height, which is slightly more stressful. Your PT’s final plan will be calibrated to your activities—more challenging for an avid tennis player than for the person who simply needs to be able to reach dishes in an overhead cabinet. But these exercises should take into account the entire kinetic chain—not just the shoulder joint but also joints above or below it, too. That’s because problems in other areas such as the shoulder blades or spine could be causing biomechanical issues that led to your rotator cuff tendinitis in the first place.
If you are given exercises to do on your own, make sure you understand what each one is designed to accomplish. Example: If you tend to sit with a rounded-shoulders posture and have tightness in the front shoulder, simple postural stretches and exercises that strengthen the shoulder’s supporting muscles should, in turn, help improve your posture. (These are likely to be exercises with arms stretched behind you or weightlifting movements that squeeze the shoulder blades back).
You may benefit from a single session with a PT to set your plan and offer guidance about exercises to do on your own, with a return visit to check on your progress. Some rehab plans include treatment from other professionals, such as a massage therapist to unlock tight muscles. Dry needling (using thin sterile needles to treat pain and movement issues) or acupuncture could have a role if trigger points around the shoulder are involved.
When a tendon is inflamed, there’s nothing to operate on. But continued wear and tear (or an injury) can lead to a tendon tear, which might require surgery to repair the rotator cuff. An MRI is usually needed to diagnose a tear, but other clues include more extreme rotator cuff symptoms such as profound muscle weakness and persistent pain with particular activities. When an acute, traumatic tear happens, some people will feel an actual pop.
You also may need surgery if an imaging test reveals a bone spur is irritating the rotator cuff tendon. In that case, surgery to trim the spur may be needed.
