Rotator Cuff Tendinitis

Shoulder pain is a common issue that affects many people’s daily lives. If you feel pain in your shoulder when lifting your arm, reaching behind your back, or while sleeping at night, the most likely cause is rotator cuff tendinitis.

In fact, the term "rotator cuff tendinitis" does not refer to a single issue; it encompasses a range of tendon problems such as damage to the supraspinatus tendon, tears in other rotator cuff tendons, or calcific tendinitis.

In this article, after briefly touching on these various tendon problems, we will focus on one of the most common causes of shoulder pain: rotator cuff tendinosis.

What Is the Rotator Cuff?

The term “rotator cuff” refers to a group of four muscles and their tendons that surround the shoulder joint. These structures work together to facilitate arm movements and stabilize the shoulder joint.The muscles of the rotator cuff are:

• Supraspinatus

• Infraspinatus

• Teres minor

• Subscapularis

These muscles enable many essential shoulder movements:

• The supraspinatus initiates arm abduction (lifting the arm to the side).

• The infraspinatus and teres minor allow external rotation of the arm.

• The subscapularis is responsible for internal rotation of the arm.

The main function of the rotator cuff is to keep the head of the upper arm bone (humeral head) firmly positioned within the shallow socket of the shoulder blade (glenoid), ensuring joint stability.

This structure plays a vital role in lifting, throwing, or rotating the arm. However, due to aging, overuse, or acute trauma, these muscles and tendons can become damaged over time.

What Is Tendinitis?

Tendinitis is the inflammation or irritation of a tendon. It typically results from overuse, repetitive motions, or aging and causes pain and restricted movement.

What Is Rotator Cuff Tendinitis?

Rotator cuff tendinitis is the inflammation of the tendons belonging to the muscles surrounding the shoulder joint. It most commonly affects the supraspinatus tendon and causes shoulder pain during arm lifting or rotational movements.

As tendon tissue deteriorates over time, degeneration (tendinosis) may also occur in addition to inflammation. Therefore, rotator cuff tendinitis is a broad term that covers both acute and chronic tendon problems.

What Is Tendinosis?

Tendinosis refers to chronic degeneration and breakdown of a tendon. Although often confused with tendinitis, it is a different condition. Tendinitis involves inflammation, whereas tendinosis is characterized by wear-and-tear changes in the tendon, including thinning and weakening, without inflammation.

This condition usually develops over time due to overuse, aging, or repetitive microtrauma.When the tendon doesn't have enough time to heal properly, its structure deteriorates, loses elasticity, and becomes more vulnerable to injury. This can cause pain, weakness, and limited mobility—and if left untreated, may progress to tendon tears.

The most common type of tendinosis in the shoulder is supraspinatus tendinosis.The supraspinatus tendon, which helps lift the arm sideways, passes through a narrow anatomical space in the shoulder, making it particularly prone to friction and wear.As a result, it is the most frequently affected tendon within the rotator cuff.

What Is a Tendon Tear?

A tendon tear refers to a disruption in the integrity of the tendon that connects muscle to bone. These tears can range from small partial fiber damage to full-thickness ruptures.They usually occur following chronic tendinosis or a sudden forceful movement.

Tendon tears may cause varying levels of pain, weakness, and limited motion depending on their location. Tears in the rotator cuff tendons, in particular, can severely impact shoulder function.

The supraspinatus tendon is the most frequently torn tendon within the rotator cuff.

To learn more about these tears, please visit the dedicated page:[Click here for detailed information on Supraspinatus Tendon Tears]

What Is Calcific Tendinitis?

Calcific tendinitis is a condition characterized by calcium deposits forming within the tendon tissue. It most commonly affects the rotator cuff tendons in the shoulder, especially the supraspinatus tendon. The calcium buildup can thicken and harden the tendon, increasing friction with surrounding tissues and causing pain.

While calcific tendinitis can sometimes be asymptomatic, it often causes intense shoulder pain and restricted movement—particularly during the resorptive phase when the calcium starts dissolving within the tendon. The pain typically begins suddenly, can wake patients from sleep, and may make arm movements difficult.

To learn more about calcific tendinitis of the shoulder, visit our detailed page.

What Are the Symptoms of Rotator Cuff Tendinosis?

Rotator cuff tendinosis usually presents with gradually worsening shoulder pain. Symptoms may start mildly but often become severe enough to interfere with daily activities. Common complaints include:

• Pain in the shoulder, especially when lifting the arm sideways or during overhead movements

• Night pain, especially when lying on the affected shoulder

• Limited range of motion in certain arm positions

• Pain that eventually occurs even at rest

• Reduced arm strength and difficulty performing specific movements

• Challenges with simple tasks like putting on a jacket or combing hair

These symptoms are typically due to damage to the supraspinatus tendon. If the tendon cannot heal, the pain may persist and lead to more serious issues such as tendon tears.

How Is Rotator Cuff Tendinosis Diagnosed?

Diagnosis begins with a thorough assessment of the patient’s symptoms and a detailed physical examination. Pain and weakness during arm lifting or rotation are key clinical clues.

Imaging methods used to confirm the diagnosis include:

• Ultrasound (US): A practical tool for evaluating tendon thickness, structural changes, and potential calcifications. It can also be performed dynamically during the examination.

• Magnetic Resonance Imaging (MRI): Provides detailed images of the tendon’s internal structure. MRI can confirm tendinosis and detect partial or full-thickness tears and intra-articular pathology.

• X-ray: Useful for detecting calcium deposits, such as those seen in calcific tendinitis, though it is less effective in visualizing soft tissues.

A critical part of the diagnosis is determining whether the tendon is inflamed or degenerated, as treatment depends on this distinction.

Treatment of Rotator Cuff Tendinosis

The main goals of treatment are to relieve pain, support tendon regeneration, and restore shoulder function.

Since tendinosis is a degenerative process rather than an inflammatory one, conventional anti-inflammatory medications and corticosteroid injections are often ineffective. Treatment instead focuses on regenerative methods:

• Rest and Activity Modification: Avoiding pain-aggravating activities and allowing the tendon to rest is crucial.

• Physical Therapy and Exercise: Targeted, controlled exercise programs significantly improve blood flow and cellular regeneration in the tendon, forming the cornerstone of treatment.

• PRP (Platelet-Rich Plasma): Growth factors derived from the patient’s own blood are injected into the tendon to promote healing.

• Stem Cell Therapy: The patient’s own stem cells may be used to encourage tissue regeneration.

• Exosome Therapy: A cutting-edge biologic treatment that enhances cellular communication and accelerates tendon healing.

• Shockwave Therapy (ESWT): A non-surgical method used to stimulate healing within the tendon.

It’s important to note that the most effective and lasting treatment for tendinosis is a tailored physical therapy program focused on the affected tendon. Other treatments support this process, but true recovery depends on active patient participation.

Exercises for Rotator Cuff Tendinitis

Rotator cuff tendinitis develops due to overuse or injury of the shoulder muscles and tendons, leading to inflammation. Specific exercises can reduce pain and improve range of motion—but must be done carefully and stopped if pain occurs.

Recommended exercises include:

• Wall Walks: “Walk” your fingers up the wall to improve shoulder mobility.

• Cross-Body Stretch: Pull one arm across your chest to stretch the shoulder.

• Theraband External Rotation: Keep the elbow at your side and rotate the arm outward using a resistance band.

• Isometric Wall Press: Apply pressure against the wall without moving the shoulder.

• Knee-Supported Plank: Maintain body alignment on your knees and forearms to enhance shoulder stability.

• Body Blade Oscillations: Perform short, controlled shaking movements with a flexible blade tool for proprioception and stabilization.

Pain during exercise is a critical warning signal. If sharp pain occurs, stop immediately. The idea of "pushing through pain" is dangerous in this context.

All exercises should be performed in a controlled manner. Rushing or performing them improperly can cause harm. Getting initial guidance from a physical therapist is highly recommended.

Conclusion

Rotator cuff tendinitis is a condition that can improve significantly with the right treatment and exercise plan. Reducing shoulder pain, strengthening muscles, and restoring mobility require a strategic and informed approach.

As Dr. Utku Erdem Özer, I am here to help you regain shoulder health with the most effective and personalized treatment options.

To learn more about your shoulder pain or to create a personalized treatment plan, feel free to contact our clinic today!