Bones / Orthopedics Sports Medicine / Fitness

What are the symptoms of rotator cuff tendinitis?

Rotator cuff tendinitis is inflammation of the connective tissues that help the shoulder to move. The condition is also called an impinged shoulder or impingement syndrome.

This form of tendinitis can be very painful and may prevent a person from performing everyday activities. When the condition is mild, a person can usually treat it with rest, home remedies, and by practicing certain exercises.

More severe cases of tendinitis tend to respond well to steroid injections or surgery.

What are the symptoms?

man holding his shoulder due to rotator cuff tendinitis
Symptoms of rotator cuff tendinitis can include shoulder stiffness, minor pain, and swelling at the front of the shoulder.

People often develop rotator cuff tendinitis by doing repeated movements, such as reaching or lifting overhead.

Symptoms are usually mild at first. The most common symptoms include:

  • pain when raising or lowering the arm
  • shoulder stiffness
  • minor pain, even when the shoulder is still
  • swelling and tenderness at the front of the shoulder
  • pain that extends from the front to the side of the shoulder
  • sudden, sharp pain when reaching or lifting
  • a clicking sound when using the shoulder

Playing some sports involves moving in ways that tend to become painful as rotator cuff tendinitis develops.

Problematic movements can include:

  • pitching a baseball
  • serving a tennis ball
  • serving or spiking a volleyball
  • using the arm to propel forward in swimming

Symptoms become more severe and persistent as rotator cuff tendinitis progresses. This can cause problems, such as:

  • pain during the night that can wake a person up or require changing positions
  • loss of strength and mobility in the shoulder
  • difficulty reaching behind the back

If rotator cuff tendinitis develops suddenly because of an injury, the shoulder will usually be extremely tender or painful. A person may be unable to move it.


Diagnosis

A doctor will begin by asking questions about symptoms, such as when they started, when they occur, and how they have progressed.

The doctor will then examine the shoulder and check for tender points or abnormalities. They will then ask the person to move the shoulder in different directions so that they can assess the range of motion.

Finally, the doctor will test the strength of the shoulder. To do this, they will ask the person to press against their hand.

To rule out other possible conditions, a doctor will usually order imaging, such as:


What are the treatment options?

In most cases, a doctor will recommend nonsurgical treatments for people with minor to mild rotator cuff tendinitis. These include:

  • resting, and especially avoiding activities that irritate the shoulder
  • applying a cold pack, or ice wrapped in cloth, to the shoulder for 15 minutes, three or four times daily
  • trying to avoid sleeping on the sore shoulder
  • taking over-the-counter nonsteroidal anti-inflammatory drugs or pain medications when symptoms flare up
  • keeping the shoulder muscles relaxed and not clenched
  • taking warm baths or showers, which can help to relax the shoulder muscles

A person may also benefit from applying over-the-counter creams, ointments, or patches that contain analgesic medications, such as:

  • menthol
  • capsaicin
  • camphor
  • methyl salicylate

In addition, a doctor may recommend physical therapy to improve symptoms and restore function.

A physical therapist will teach a person stretches that can improve the range of motion in the shoulder.

Once the person can move their shoulder without pain, the physical therapist will teach them strengthening exercises to help fully restore the use of their shoulder.

A doctor may suggest steroid injections if rest, basic care, and physical therapy do not resolve symptoms.

The steroid will have strong anti-inflammatory properties. The doctor will inject it directly into the shoulder. They will also use a local anesthetic.

They will often need to repeat these injections every few months until the shoulder responds to less invasive treatments.


Exercises

Some basic stretches and exercises can help to manage or treat rotator cuff tendinitis.

Before trying them at home, it is important to warm up the body for 5–10 minutes by doing some low-impact cardio exercise, such as walking.

Three exercises that tend to benefit people with rotator cuff tendinitis include:

The pendulum

  • Lean forward with the knees bent and the back flat.
  • Rest one hand on a flat, solid surface with an overhang, such as a table or countertop.
  • Let the unsupported arm fall free and swing it forward and backward, then from side to side, then in a circular motion.
  • Repeat the exercise 10 times, then rest for 1–2 minutes, then repeat 10 more times.

Next, do two sets of ten repetitions each using the opposite arm. It may be a good idea to repeat this exercise on both arms 5–6 days a week.

The crossover

deltoid pain stretch 2
The crossover exercise may help to manage or treat rotator cuff tendinitis.
  • Standing straight, bend the knees slightly, and relax the shoulders.
  • With one hand, gently grasp the opposite upper arm, and pull the arm across the chest as far as is comfortable.
  • Hold this stretch for 30 seconds before releasing.
  • Rest for 1 minute, then repeat the stretch on the opposite arm.

A person may benefit from performing this stretch four times on each arm daily.

An individual should feel the stretch in the back muscles behind the shoulders.

The backwards pull

  • Stand straight with the knees slightly bent. Hold a very lightweight stick, such as a yardstick or a thin broomstick, directly behind the body.
  • Slowly pull the stick to one side as far as is possible without pain, making sure not to bend, twist, or lean.
  • Hold the stretch for 30 seconds before releasing.

Rest for 1 minute and repeat on the opposite side. Repeat this exercise four times on each side, 4–5 days a week.

Surgery

If all other forms of treatment fail, a doctor may recommend surgery. The appropriateness of surgery can depend on:

  • the severity of the tendinitis
  • whether the tendon is torn or damaged
  • a person’s age
  • their overall health
  • their physical demands, possibly involving jobs or hobbies
  • whether the tendinitis is chronic or has developed suddenly, following an injury, for example

The surgeon will remove portions of the bursa, a fluid-filled sac that sits within the rotator cuff. A healthy bursa helps the shoulder bones and tendons to move without friction.

The surgeon may also remove a piece of the acromion, which is a bone at the top of the shoulder. They usually remove the front edge.

It takes most people 2–4 months to fully recover from surgery for rotator cuff tendinitis.

In the first few weeks of recovery, a person will usually wear a sling to reduce pressure and stress on the healing shoulder.

Once the shoulder is no longer painful, a person can begin stretching and doing strengthening exercises recommended by a doctor or physical therapist.


Prevention

Pitching a baseball may cause rotator cuff tendinitis
Using the correct technique when playing sports can help to prevent rotator cuff tendinitis.

The best way to prevent rotator cuff tendinitis is to avoid or limit activities that irritate the shoulder. Taking this precaution can also help a person with the condition to reduce the number of flare-ups.

People who play sports that involve the shoulder should ensure that they are using correct technique to limit irritation as much as possible.

The following tips can also help to prevent or manage rotator cuff tendinitis:

  • Stretch the shoulders throughout the day.
  • Take breaks from repetitive motions, movements, or postures.
  • Use a good posture when sitting, standing, and walking.
  • Sleep on the back or alternate sides.
  • Carry heavy objects as close to the body as possible.
  • Rest the shoulder as soon as pain begins.
  • Refrain from making too many repetitive or forceful overhead motions.

Complications

Depending on how the severity of the tendinitis and a person’s profession or hobbies, the condition can cause complications, including:

  • chronic pain
  • a lack of mobility
  • difficulty with motions such as throwing or lifting
  • reduced strength and flexibility in the muscles of the shoulder, arm, chest, and back
  • difficulty sleeping or insomnia
  • trouble keeping the arms raised enough to drive

As with any surgery, the procedure to correct rotator cuff tendinitis involves some risks, most commonly:

  • bleeding
  • scarring
  • unintentional tissue damage
  • a negative reaction to sedative medications


Takeaway

It may take a person weeks or months to recover from rotator cuff tendinitis and regain full, pain-free use of the shoulder.

However, when the condition is mild, most people can achieve a complete recovery with rest, at-home care, and over-the-counter medications.

People with more severe tendinitis may require additional treatment. This usually involves steroid injections. If nothing else works, a doctor may recommend surgery. When followed by the right recovery plan, this surgery is typically successful.

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