Rotator cuff tendinitis is a painful tendon at the top of the shoulder. It hurts reaching overhead or behind your back, and often at night.
Despite the name, it usually ISN’T inflammation. The tendon fibers are worn and struggling to repair, which is why anti-inflammatory tablets rarely fix it long term. That’s why many doctors now call it tendinopathy.
The best treatment is exercise that loads the tendon and gets harder over at least 12 weeks. Most people get better over a few months. About 3 in 4 are pain-free at five years.
Symptoms
- Pain over the outer shoulder and upper arm, linked to activity
- Worse reaching overhead or behind your back
- Night pain, often bad enough to wake you
- Pain when you push or lift against resistance, and sometimes weakness
- Someone else can move your arm fully. If they can’t, it’s more likely frozen shoulder
What’s going on in the tendon
- Early (reactive): the tendon swells a little after a sudden jump in load. Fully reversible with less load and time
- Middle: the tendon tries to repair but struggles. It can take less load than before
- Late (degenerative): areas of worn tendon that don’t reverse, but that often cause no pain on their own
- A tendon can flare suddenly after something ordinary, when the healthy part next to an old worn patch gets overloaded. That’s why a shoulder can go from fine to painful “for no reason”
It’s a tendon that’s lost some of its capacity. You rebuild capacity with load, not rest.
Who gets it
- Over 50: about three times more likely
- Diabetes: about twice as likely. Good blood sugar control matters for the tendon too
- Overhead work with your hands above shoulder height: more than twice as likely
- Also linked: heavy or repetitive manual work, swimming and weight training
Do you need a scan?
- Usually not. Scans find “damage” in lots of people with no pain
- About half of people over 60 with NO shoulder pain have a cuff tear on a scan
- Scan when: there’s real weakness after an injury, things aren’t adding up, or surgery is being considered. See rotator cuff tear
What helps
- Exercise: the best-supported treatment. Load the tendon, stay consistent for at least 12 weeks, and make it harder over time. No single type of exercise has been proven clearly best, and doing it at home works. See the 12-week shoulder program
- A steroid injection: helps pain in the short term. The benefit fades over months. Leave at least three months between injections into the same shoulder, and don’t rely on repeated ones. See how long a cortisone shot lasts
- Shockwave: the strongest evidence is for calcium deposits in the tendon, a different problem. Weaker evidence without calcium
- PRP injections: mixed results. US orthopedic guidance doesn’t support routine use
- Hands-on therapy: may help a little, alongside exercise
- Therapeutic ultrasound: doesn’t work better than placebo. If it’s on your plan, ask why
How much pain is OK during exercise?
- Up to about 2 to 5 out of 10 is fine, as long as it settles soon after
- It should be back to your normal by the next morning
- It shouldn’t climb week after week
- Change one thing at a time, weight, reps or how often, and judge it over 24 hours
- Very irritable shoulder? Start with holds against resistance without moving (isometrics), with the arm supported
Do you need surgery?
- Without a significant tear, usually no. Shaving bone to “make room” did no better than exercise alone over ten years, and no better than a fake operation. See shoulder impingement
- A sudden, significant tear after an injury in a younger person is a different situation
How long it takes
- Most people improve over a few months with exercise and activity changes
- About 1 in 4 are still sore years later
- Slower recovery is more likely if you’ve had symptoms over a year, or time off work over two weeks before starting treatment
Get help today if
- You have a fever with a hot, swollen shoulder
- You have shoulder pain with chest pain, breathlessness or sweating. Call emergency services
- Your shoulder looks deformed after a fall
Get it checked if
- You have a history of cancer with constant night pain, night sweats or a lump
- You can’t lift the arm after an injury
- Twelve weeks of progressing exercise haven’t helped
Not inflamed, just underloaded. Rebuild it with twelve weeks of exercise that gets harder.