Your shoulder is a complex ball-and-socket joint made up of bones, muscles, tendons and ligaments that allow you to move in a wide range of motion. At the heart of your shoulder movement is the rotator cuff, a group of four muscles and their tendons that work together to help stabilize and move your shoulder. The rotator cuff is one of the most important structures for maintaining shoulder joint function and allows you to:

• Lift your arm
• Rotate your shoulder
• Do overhead movements

Due to your shoulder being involved in so much movement, it’s likely that you may be part of the 26% of people who suffer from shoulder pain at any given time. Rotator cuff issues that cause shoulder pain include:

• Rotator cuff tendinitis
• Rotator cuff tear
• Rotator cuff bursitis
• Impingement syndrome

Tendinitis vs. bursitis

Tendinitis and bursitis are both common conditions that can affect your shoulder. However, there are some key differences between the two conditions:

• Rotator cuff tendinitis — Rotator cuff tendinitis is the inflammation or irritation of the tendons in the rotator cuff. This can cause you to experience pain and difficulty when trying to move your shoulder, especially when doing activities that involve lifting or rotating your arm. 
• Bursitis — Bursitis is the inflammation of the bursa, a small fluid-filled sac that provides cushion to the tendons and muscles around the shoulder joint. Bursitis can cause symptoms such as localized swelling and pain, especially when pressure is put on the affected area. 

Both conditions can cause shoulder pain, stiffness and weakness. They can both make it hard for you to do everyday things like reaching overhead or lifting objects. While rotator cuff tendinitis and bursitis share similar symptoms, the key difference is in the location and type of inflammation. People with rotator cuff tendinitis may also experience bursitis if the inflammation spreads to the surrounding structures in their shoulder joint. 

Common symptoms of rotator cuff tendinitis include:

1. Shoulder pain
2. Shoulder swelling
3. Shoulder stiffness
4. Limited range of motion in the shoulder and arm
5. Reduced arm strength
6. Clicking sound or cracking sensation in the shoulder when moving
7. Pain when lifting the arm

Causes and risk factors of rotator cuff tendinitis 

Rotator cuff tendinitis can develop over time due to repetitive motion or overuse of the shoulder joint. Causes of this condition can include:

• Overuse or repetitive activities
• Age-related wear and tear
• Trauma or injury
• Poor posture or biomechanics
• Bone spurs
• Previous shoulder injury
• Weak rotator cuff muscles

There are several groups that can be more susceptible to developing rotator cuff tendinitis, including:

• Older adults — If you’re in your 20s, you have a 5% to 10% chance of developing this condition, and your chances drastically increase to 60% to 65% when you’re 80 years or older. 
• Athletes — Athletes who do sports that involve a lot of overhead movements, such as baseball, tennis and swimming, are at a higher risk of developing this condition. 
• Workers — People who work in jobs that involve repetitive overhead movements, such as painting, construction or manufacturing, can be at a higher risk. 

How is rotator cuff tendinitis diagnosed?

Rotator cuff tendinitis can be diagnosed by a physical examination and imaging tests. During a physical examination, your doctor will assess your range of motion, strength and pain. Imaging tests, such as MRIs or X-rays, can help to rule out other conditions, confirm diagnosis and determine the severity of the condition. 

The four stages of shoulder tendinitis are:

• Overuse tendinitis — This stage of tendinitis is caused by repetitive motions that lead to irritation, bruising or even fraying of the tendon. 
• Calcific tendinitis — If rotator cuff tendinitis is left untreated, calcium deposits can build up within the tendons and cause pain and a loss of strength and motion. 
• Impingement tendinitis — When the bursa is inflamed, the rotator cuff is weak or there’s a bone spur present, the space between the rotator cuff and coracoacromial arch can become narrowed. When this happens, the humerus pinches the rotator cuff.
• Rotator cuff tear — If impingement, injuries or degeneration are left untreated, or in the event of a sudden impact, the rotator cuff can be partially or completely torn. 

Complications of untreated rotator cuff tendinitis

If left untreated, rotator cuff tendinitis can cause a number of complications, including:

• Impingement syndrome
• Rotator cuff tear
• Chronic pain
• Range-of-motion limitation
• Muscle weakness

Treatments for rotator cuff tendinitis symptoms

You don’t have to deal with the symptoms of rotator cuff tendinitis for longer than necessary. There are several treatments that can help you treat and manage your symptoms, including: 

• Rest and activity modification — One step to take to help manage your symptoms is to rest your shoulder or change how you do activities to avoid aggravating your condition. This can help limit strain on your shoulder and give the inflamed tendons time to heal. Some movement is still important to help prevent stiffness. 
• Cold and heat therapy — Cold therapy is a simple and effective way to help reduce pain and inflammation in early stages of tendinitis. Using an ice pack for 15 to 20 minutes every four to six hours on the affected shoulder can help reduce swelling and numb the area, providing you with relief. Heat therapy can be helpful once inflammation has gone down. Heat helps boost blood flow to the area, which can promote healing and relax tight muscles. 
• Pain relieving medication — Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage pain and reduce inflammation. For more severe pain, your doctor may prescribe prescription pain relievers. It’s crucial to follow dosage instructions. 
• Physical therapy — Physical therapy can help reduce pain and inflammation, restore range of motion and flexibility, strengthen rotator cuff and surrounding muscles to improve stability, and teach proper body mechanics to help avoid further shoulder strain. 
• Corticosteroid injection — In more severe cases, your doctor may prescribe a corticosteroid injection directly into the affected shoulder joint. Corticosteroid injections deliver powerful anti-inflammatory medications that can quickly reduce your pain and swelling. 
• Surgery — In cases where rotator cuff tendinitis has progressed to cause a tear or if conservative treatments haven’t been effective, surgery may be necessary. There are two types of surgery options, depending on the extent of the damage:
• Arthroscopic surgery
• Open surgery

Physical therapy treatments for rotator cuff tendinitis 

Physical therapy can be an integral part of your recovery from rotator cuff tendinitis. Your physical therapist will create a personalized treatment plan to address your unique symptoms and recovery goals. They may use a variety of specialized techniques, such as:

• Therapeutic exercises — These exercises are designed to help stretch and strengthen the muscles around your shoulder. They help to improve your flexibility, stability and strength. Therapeutic exercises are gradually increased in intensity over time to help avoid overloading your tendons and ensure that you regain your full shoulder strength and mobility. 
• Instrument-assisted soft tissue mobilization (IASTM) — IASTM is a technique where your physical therapist will use specially designed stainless steel tools to glide over your skin to find and treat areas of tension or scar tissue in your shoulder. This technique can break down adhesions, reduce inflammation and improve blood flow to promote healing and enhance your flexibility. It can also help decrease pain and stiffness, which can make it easier for you to do therapeutic exercises.
• Manual therapy — Manual therapy is an umbrella term for hands-on techniques your physical therapist uses to manipulate the muscles, tendons and joints. These techniques include:
• Soft tissue manipulation — Your physical therapist will use their hands to apply gentle pressure to tight muscles and tendons around your rotator cuff. This can help loosen the tissue, promoting relaxation and reducing discomfort. 
• Joint mobilization — Your physical therapist will use their hands to gently move your shoulder joint in specific directions to help release stiffness and improve the overall range of motion. This technique can also help decrease pain and allow your shoulder to move more freely. 
• Trigger point therapy — Trigger point therapy involves your physical therapist applying pressure to specific tight areas in the soft tissue in your shoulder that cause pain. This pressure can help release tension, reduce pain and restore normal muscle function. 
• Electrical stimulation — Your physical therapist will place electrodes on the skin near your affected shoulder. These electrodes send mild electrical pulses to the muscles and tendons, stimulating them to contract and relax. It can help boost circulation, reduce pain and promote healing. 
• Pre- and postsurgical rehabilitation — If you require surgery, physical therapy can be helpful before and is essential after your surgery. Presurgical PT will focus on strengthening the muscles around your shoulder to help you have a smoother recovery, and postsurgical PT will focus on restoring your strength and mobility. 

Lattimore PT can help you heal from rotator cuff tendinitis with confidence

At Lattimore PT, we understand how difficult dealing with rotator cuff tendinitis can be and how important it is to find relief. Our skilled physical therapists, including over 30 with their Certification in Orthopedic Manual Physical Therapy, strive to provide high-quality and personalized care, tailored to help you recover as efficiently and safely as possible. Let us guide you on your journey to recovery. 

Contact our team today for more information or to schedule an initial appointment.