Rotator Cuff Tendinopathy: A Complete Guide of Causes, Symptoms and How To Fix Tendonitis

Joseph Rosi
March 16, 2023
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If you’ve been experiencing pain in your shoulder, it’s time to take action. Rotator cuff tendinopathy is a common shoulder condition I see regularly in the clinic. This blog post will talk about what causes this condition, how it presents itself and how to fix it. The symptoms can include pain in the front, back or outer part of the shoulder as well as weakness in rotating your arm outward and difficulty lifting objects or raising your arm over head height. This isn’t something that will just go away by itself or get better over time without treatment. You may go through phases where it feels a little better, but it is always followed up by another bout of discomfort and pain until the root of the problem is actually addressed. It’s important for you to know what the problem is, and address it early so you can prevent further damage and get back to living your life!

What is Rotator Cuff Tendinopathy?

There are several different types of tendinopathies, but rotator cuff tendinopathy is one of the most common and debilitating. Rotator cuff tendinopathy is a condition where one or more of the rotator cuff muscles and tendons, which stabilize the shoulder, become irritated. Your rotator cuff is a group of 4 small muscles that surround the shoulder joint in your upper arm.

Rotator cuff tendinopathy usually develops gradually so you may experience some soreness or stiffness before you have any pain. Rotator cuff tendinopathy occurs as a result of overuse or irritation of the rotator cuff tendons. It can be caused by a new or repetitive movement that puts more stress on your shoulder muscles than they are used to. The symptoms include pain and stiffness in the shoulder region, pain raising your arm above chest height and weakness in both lifting weights and pushing things with your arm.

There are 4 stages of rotator cuff tendinopathy:

1. Acute (reactive) tendonitis – This is the first stage and can last for up to two weeks. The cause of this stage is either an acute injury, overuse or some new stimulus where there is more stress on your rotator cuff than you’re used to. During this phase you may experience pain, inflammation, swelling and warmth in your shoulder. You may also notice clicking or popping sensations when you move your shoulder.

2. Subacute tendonitis – After two weeks symptoms will start to subside. You’ll feel less pain, but the tendinopathy is still there. This is an important phase to treat because it’s when you can prevent it from getting worse and having a lasting effect on your shoulder.

3. Chronic (dysrepair) tendinopathy – If you do not treat your rotator cuff during this stage you risk permanent damage. The inflammation will begin to get stronger and the tissues will become degenerated. You’ll experience pain, weakness in lifting weights or pushing things with your arm (like a shopping cart), stiffness of the shoulder and decreased range of motion. People that reach this stage are often on a rollercoaster with their symptoms where they have bouts of pain that subside and then they never actually address it and it comes back and the cycle continues.

4. Rotator Cuff Tear – If you don’t treat the rotator cuff tendinopathy, eventually the tissues can fray and you can tear your rotator cuff. This usually results in a lot of pain and difficulty even moving your arm, so it is important to get it addressed.

For more information on these stages of tendinopathy watch the following video.

What are the Symptoms of Rotator Cuff Tendinopathy?

The most common symptoms of rotator cuff tendinopathy are:

1. Pain that is worse at night or after activity. This is due to the chemical changes happening from the activity that is irritating the tissues and the build up of these chemicals at night. This pain is most often felt along the top of the shoulder where the tendons attach and can radiate down the arm.

2. Swelling and warmth at and around the shoulder joint

3. Weakness in moving parts of the shoulder area such as turning your arm outwards or lifting it above your head.

4. Stiffness in your shoulder and/or clicking and popping sensations

5. Numbness or pins and needles. Some people feel a tingling sensation down their arms to their fingers related to this problem.

6. Pain that wakes you from sleep, especially if your movement during the night irritates it further — for example by lying on your side or rolling over onto it while asleep. You may lie awake at night and find yourself unable to get comfortable because of pain or numbness from lying on the affected shoulder for too long.

If you are having trouble finding a comfortable position to sleep in, we put together a video to help you out.

7. Your shoulder may have stiffness and pain first thing in the morning when you get up. This stiffness eases a little after activity or movement but worsens again at rest — especially if resting with your affected arm hanging down straight by your side.

Who is More Likely To Develop Rotator Cuff Tendinopathy?

A person is more likely to develop rotator cuff tendinopathy if they have an underlying shoulder weakness or imbalance present before they start doing a new or more frequent repetitive movement, especially with excessive overhead activity. Excessive use or repetitive movements of the arm can lead to rotator cuff injuries and certain types of activities are more likely to irritate the tendons.

People have a higher chance of getting rotator cuff tendinopathy that are in occupations such as :

      • workers in the building industry as it is common for these individuals to lift heavy objects and may have repetitive movements of their upper limbs. Their workstations are usually small and cramped, making them more vulnerable to injury.
      • manufacturers or assemblers who are exposed to machinery with repetitive motions all day long
      • those who use vibrating tools/equipment at work on a daily basis (electricians, carpenters etc)
      • occupations requiring repetitive overhead motions such as construction jobs, assembly line work, painting or electricians

There are also certain sports where people have a higher likelihood of developing rotator cuff tendinopathy. Sports where there is a repetitive high stress and load placed upon the shoulder joint and surrounding rotator cuff muscles are more likely to develop rotator cuff tendinopathy. These include baseball, boxing, tennis, swimming, football, volleyball and rugby.


How to Know if You Have Rotator Cuff Tendinopathy?

Just because you have some of the above symptoms does not mean that you necessarily have rotator cuff tendinopathy. There are many shoulder and neck issues that can mimic rotator cuff tendinopathy. The best way to know if you have rotator cuff tendinopathy is to get assessed by a physical therapist and have them lay out the best course of action specific to you.

It is important to rule out other conditions that can mimic a rotator cuff injury. For example muscles and nerves in the cervical region and shoulder can refer pain to places that may seem like your rotator cuff is involved when it is not. Also, if you’re experiencing pain in two different parts of the shoulder region, then there could be two problems that need to be addressed. Sometimes specialists focus so much on one particular body part when diagnosing injuries that they don’t look at the surrounding areas that may be contributing to the problem. Physical therapists are very good at looking at the whole body or region to truly address what is going on. So if you are wanting to skip the frustration of not knowing what is causing your pain or potentially trying to treat something that is not the main culprit, a physical therapist is the best person to see.


Types of Treatment for Rotator Cuff Tendinopathy

When the tendon is irritated, the BEST solution is for the tendon to get the appropriate load to reduce the symptoms and heal. Then the tendon needs to get stronger to prevent any recurrence of injury. This is especially true because an irritated tendon is a warning sign and if it is not taken care of, the tendon will continue to weaken and could progress into a tear, which may ultimately need surgery. Surgery is only warranted in some cases for tears, but not tendonitis. Tendinopathy can be addressed early on and prevent further damage. A physical therapist is the musculoskeletal expert and this is where they shine. They also specialize in activity modification and progressively loading the injury appropriately to be able to fully get back to everything pain free and without limitation.

Initially, when the tendon irritation is new and reactive- heat, massage and light movements can increase blood circulation and help to flush out chemical irritants contributing to pain. Injections can also be utilized to reduce inflammation in the area and help reduce pain. But, often people mistake the decrease in pain to correlate with a healed tendon. This is not the case. Once your symptoms have reduced, this is the optimal time to improve the strength and integrity of the tissues to prevent any further damage. The goal is to get that tendon stronger and more resilient so the irritation does not come back and you are able to get back to all your previous activities without limitation.


How Long Will Rotator Cuff Tendinopathy Take to Heal?

The majority of tissue healing (80%) happens within 6 weeks. This is the case when the body has the optimal conditions to heal. For example, the initial stimulus causing the irritation has reduced, the tendon is getting the movement and light load initially that it needs to heal and there are no other factors such as diabetes, or taking anti-inflammatories that are delaying the healing process. It is important that you allow your injury enough time to heal and recover properly before you fully resume everything. Often people fully resume activity and do too much too quickly when they start to feel better. But the injury has not fully healed and they set themselves back and start to have pain again and then a week later feel a little better and just keep repeating the process and prolong their healing time. Do it right the first time and let your body heal.

For guidance on what to do the initial 72 hours after an injury, watch the following video. This will guide you to create the best circumstances for your body to heal quickly and efficiently.


Rotator cuff tendinopathy is a common injury for people who play contact sports, lift weights or do repetitive work. The symptoms of rotator cuff tendinopathy are pain and weakness in the shoulder that can worsen with time if left untreated. There are several treatment options available to help alleviate the discomfort associated with this condition including physical therapy, injections and temporary activity modification. If you’ve been experiencing these symptoms, addressing it early is key to shorten your healing time and prevent further damage. See a physical therapist so they can diagnose your condition and recommend an appropriate course of action tailored specifically to you.


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    Dr Joseph Rosi II, DPT, Cert DN, CSCS

    Dr. Rosi was born and raised in Dayton, OH. He graduated from The University of Findlay with a dual degree – a Bachelors of Science in Kinesiology as well as a Bachelors of Arts in Spanish where he was immersed in the culture and lived in Costa Rica while studying at La Universidad de Costa Rica- San Pedro.  He then returned to University of Findlay and continued to graduate school to pursue his Doctor of Physical Therapy degree. During this time he completed mission work in Nicaragua, in which he served many young families who were unable to access the most basic forms of healthcare. 

    After graduation, he set out to continue to learn and enhance his hands-on clinical skills, where he spent the next two years completing a Manual Therapy Certification from The University of Saint Augustine in St. Augustine, FL.  During this time he also completed his certification in Dry Needling from the American Academy of Manipulative Therapy. He also took coursework and furthered his specialty into male pelvic health. During this time he traveled, learned and worked in many different clinics in multiple states including Ohio, Texas, Indiana, South Carolina, New Mexico, California, and now Florida where Alinea Performance was born.

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