What is Rotator Cuff Tendinopathy? The Symptoms & Treatment Options

According to the University of New South Wales, 65-70% of all shoulder pain conditions are rotator cuff conditions.[1] Approximately 170,000-180,000 Australians present to their GP with a rotator cuff issue.[1] Additionally, those over 50 have 3.3 times the risk of developing rotator cuff tendinopathy[2].

While similar, tendinopathy and tendonitis are not the same. The key difference is the minimal or lack of inflammation seen during tendinopathy. This is significant as those with tendinopathy may not respond as well to some anti-inflammatory treatments, such as medication and steroid injections.

Read on to understand what you should know about rotator cuff tendinopathy; the risk factors, treatment options and expected recovery time.

What is Rotator Cuff Tendinopathy?

Rotator cuff tendinopathy describes progressively painful changes to the tendons of the rotator muscles (e.g. supraspinatus, infraspinatus, teres minor and subscapularis). These muscles support the shoulder, particularly when moving overhead. Unlike tendonitis, where inflammation occurs, tendinopathy undergoes structural changes, including swelling, wearing and weakness.

So what is the rotator cuff?

The rotator cuff is a group of muscles that stabilises the shoulder and allows various movements such as rotation and lifting your arms. These muscles are:

• Supraspinatus

• Infraspinatus

• Subscapularis

• Teres Minor.

Excessive stress due to repeated shoulder activities can cause micro-tears and inflammation on the rotator cuff tendons, leading to stiffness and weakness over time.

Other factors such as poor posture, age and shoulder muscle weakness can also result in degeneration of the rotator cuff tendons.

What are the symptoms of rotator cuff tendinopathy?

The main symptoms of rotator cuff tendinopathy include pain and swelling at the front of the shoulder joint, loss of strength and joint stiffness. People may also experience a clicking or popping sensation when lifting overhead.

Common symptoms of rotator cuff tendinopathy

• Pain on the front part of the shoulder and side of the arm

• Pain when reaching behind the back

• Painful overhead reaching

• Swelling around the shoulder joint

• Pain upon raising or lowering your arms

• Pain when sleeping on the shoulder

• Shoulder blade pain

• Right shoulder and arm pain

• Clicking sound during arm movements

• Stiffness

• Weakness

• Loss of range of motion

What causes rotator cuff tendinopathy?

Rotator cuff tendinopathy is usually caused by overuse and general wear and tear. Certain activities like heavy lifting, repetitive movements and sports that require a lot of shoulder movements such as swimming, tennis and cricket are the primary causes.

Common causes of rotator cuff tendinopathy

• Repeated overhead movements of the shoulder

• Not enough rest periods in between shoulder activities

• Poor posture

• Poor biomechanics of the shoulder joint

• Recurring injuries on the shoulder

Sports that increase the risk of rotator cuff tendinopathy

Sports that involve repeated overhead arm movements with high velocity are prone to having rotator cuff tendinopathy over time.

• Baseball

• Basketball

• Volleyball

• Swimming

• Tennis

How is rotator cuff tendinopathy diagnosed?

Rotator cuff tendinopathy can occur along with other shoulder conditions. Furthermore, pain and inflammation of the rotator cuff tendon can prevent you from participating in sporting activities or daily activities.

There are several options available when it comes to diagnosing your shoulder pain as rotator cuff tendinopathy. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are experts in the field of joint and movement rehabilitation. They are highly-qualified to diagnose and deal with musculoskeletal conditions such as rotator cuff tendinopathy.

Your physiotherapy assessment is similar to your visit to a GP. Your physiotherapist will begin the consultation with a mini-interview about your health status and history of previous injuries. Use this time to discuss all of your concerns regarding your condition.

After getting your history, your physiotherapist will then perform physical tests to identify various factors causing your symptoms and rule out other possible conditions.

Your physiotherapist will then create a specific treatment plan for you and will guide you through your recovery.

This will also include:

• Target treatment goals and time of your recovery

• Home exercises to keep you active even at home

• Expert advice to support your recovery

• Tailored treatment program based on the level of your activities.

How is rotator cuff tendinopathy treated?

Rotator cuff tendinopathy is an injury resulting from faulty biomechanics and repeated stress on your shoulder joint. Unless you address physical impairments of your shoulder joint, there’s a high chance you may reinjure your shoulder and worsen your condition.

There are several options when it comes to treating rotator cuff tendinopathy. One of the more common and the treatment option referred to by Australian GPs the most is physiotherapy.

Rotator cuff tendinopathy is an injury that physiotherapists routinely encounter at the clinic. They are the go-to professionals when it comes to treating joint and tendon injuries. Physiotherapists are in the best position to give quality care and help you regain your normal function.

Your treatment will focus on managing your pain, improving your range of motion and stabilising your shoulder to prevent complications and restore the natural movement of the shoulder.

Depending on the severity of your rotator cuff tendinitis, a physiotherapist may provide you with a combination of the following types of treatments:

• Soft Tissue Mobilisation - Hands-on techniques aimed at reducing muscle spasm in the shoulder region.

• Strengthening Exercises - Focusing on muscles of the shoulder, especially the rotator cuff muscles.

• Joint Mobilisation Techniques - Rhythmic or sustained pressure applied to the shoulder joint to reduce pain and increase joint mobility.

• Manual Therapy - Specialised hands-on treatment used by your physiotherapist to improve your joint mobility, increase range of motion and reduce pain.

• Kinesio Taping Techniques - Specialised taping to help stabilise the shoulder which can also decrease pain.

• Therapeutic Exercises - Corrective exercises to promote natural shoulder movements.

• Stabilisation Exercises - Designed to increase the stability of your shoulder and correct shoulder mechanics.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.

Next step - Creating a treatment plan made for you

Your physiotherapist will create a detailed treatment plan based on your assessment and goals to help you achieve full recovery.

Self-care for rotator cuff tendinopathy

If you think you have rotator cuff tendinopathy, here are the best things you can do and avoid.

Things to do:

1. Rest

Allow your body to heal correctly by taking a break from activities that cause your shoulder pain. Aside from limiting the use of your shoulder, remember to stay active to prevent deconditioning.

2. Apply cold compress

Apply ice or cold packs regularly for 15 minutes to reduce swelling and pain.

3. Apply hot compress

Once the inflammation subsides, you can start using a hot compress to reduce stiffness and muscle spasm.

4. Stretch

Do self-stretching to relieve joint and muscle stiffness and maintain your range of motion. Your physiotherapist will teach you

5. Observe proper posture

Posture plays a crucial role in your shoulder mechanics. Slouching can decrease the space on the shoulder joint where the tendons are gliding through, which may increase the risk for a shoulder injury.

Things to avoid:

1. Avoid overhead activities

Limit overhead activities to avoid excessive stress on the rotator cuff tendons while the tendons are healing.

2. Limit sport activities

Limit sports activities that rely on shoulder movements until your shoulder is fully healed. Consult a physiotherapist to guide you in your training.

Do I need a specialist or surgery?

Your previous shoulder injuries and medical history will likely tell which structures in your joint may have been affected. Additional movement screening and tests can pinpoint specific structures that cause your symptoms.

Supporting assessments can be done to help with the diagnosis if needed:

• X-ray - used to check for bone damage and status of your joint space.

• MRI - used to detect soft tissue injuries such as affectation of the ligaments and tendons.

• CT- can also be used to evaluate soft tissue structures.

• Blood test - can be done if a systemic infection is suspected.

Your GP may prescribe you anti-inflammatory medications to manage your symptoms.

In severe rotator cuff tendinopathy, surgery may be performed to remove bone spurs on the shoulder to allow smooth gliding of the rotator cuff tendons. Tears on the tendon can also be repaired surgically.

Your GP may refer you to a physiotherapist to rehabilitate your shoulder and help you optimise your recovery.

What is the recovery time / prognosis for rotator cuff tendinopathy?

Ultimately, recovery time is dependent on being proactive and seeking professional treatment along with the severity of your shoulder pain and injury.

Full recovery from rotator cuff tendinopathy can be achieved within 2 to 4 weeks. However, stubborn cases or unexpected complications can prolong the recovery period for months.

Physiotherapy helps improve the overall outcome of patients who are suffering from rotator cuff tendinopathy. Physiotherapists will facilitate your gradual return to function with careful consideration of your condition.

Can rotator cuff tendinopathy be prevented?

These tips will decrease your risk of having rotator cuff tendinopathy or promote your recovery if you already have it.

• Avoid excessive overhead activities - Pace your activities and make sure that you allow sufficient rest for your shoulders to recover.

• Strengthen your shoulders – Strengthening exercises for the rotator cuff muscles will make them more resilient to stress and allow them to overcome greater loads.

• Observe proper posture – Proper posture promotes healthy joint and muscle interaction. It also decreases the tension in your muscles.

• Observe proper training techniques - Specific throwing or swimming techniques will allow less stress on your rotator cuff tendon and shoulder joint. Ask your sports physiotherapist or coach to guide you through your training.

Outlook and the main takeaways

Rotator cuff tendinopathy is an overuse injury resulting from various factors, including posture, joint biomechanics, and repetitive stress on your tendons.

Pain and discomfort during overhead or throwing activities is usually a sign of damage on your rotator cuff tendon.

It is best to catch these symptoms early and start treating them immediately to prevent complications. Book a visit to your physiotherapist today and have a complete assessment of your rotator cuff to start your recovery.

Anatomy of the rotator cuff

Your rotator cuff is a group of muscles located on your upper back which controls a wide range of movement of your shoulders and arms, especially overhead movements (external rotation and abduction of the shoulder).

• Supraspinatus - Holds the humerus in place and is responsible for lifting the arms.

• Infraspinatus - Rotates and extends the arms.

• Subscapularis - Rotate the shoulders inward

• Teres Minor - Assist arm rotation

The rotator cuff muscles stabilise the shoulder joint and prevent dislocation. They are responsible for high-intensity shoulder movements, as seen in throwing and swimming motions.

The tendons of your rotator cuff pass through a space called subacromial space. Inefficient biomechanics and poor posture can narrow the subacromial space, which results in irritation of the rotator cuff tendons.

Repeated stress on a weak rotator cuff can also lead to the tendons’ injury and degeneration, resulting in tendinopathy.