Rotator Cuff Tendinitis

Tendinitis (also spelled “tendonitis”) is an inflammation or irritation of a tendon, which is a thick cord that attaches muscle to bone. This condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your tendons, it’s most commonly found around the shoulders, elbows, wrists, knees, and heels.

Common types of tendinitis include:

Tennis elbow: Affects the outer elbow tendon, often due to repetitive wrist and arm motions.
Golfer’s elbow: Affects the inner elbow tendon, similar to tennis elbow.
Pitcher’s shoulder or swimmer’s shoulder: Affects the tendons in the shoulder.
Jumper’s knee: Involves the tendon attaching the kneecap to the shinbone.

Causes:

Tendinitis is typically caused by a repetitive, minor impact on the affected area, or from a sudden, more serious injury. Many activities that can cause tendinitis, including gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing, and throwing and pitching.

Incorrect posture at work or poor stretching or conditioning before exercise or playing sports also increases a person’s risk. Sometimes, tendinitis stems from an infection, such as gonorrhea.

What Is Rotator Cuff Tendinitis?

Rotator cuff tendinitis, also known as rotator cuff tendinopathy, is a condition characterized by irritation, inflammation, and degeneration of one or more of the tendons of the rotator cuff muscles in the shoulder. This condition typically arises due to overuse or acute injury, resulting in pain, tenderness, and impaired movement of the shoulder joint.

The rotator cuff itself is an anatomical ensemble composed of four muscles and their associated tendons that attach the humerus (the upper arm bone) to the scapula (shoulder blade). These muscles include the supraspinatus, infraspinatus, teres minor, and subscapularis.

Each of these muscles plays a pivotal role in stabilizing the glenohumeral (shoulder) joint and allowing for a wide range of motion, including lifting, rotating, and providing the fine motor control necessary for complex arm movements.

When functioning properly, the rotator cuff works seamlessly to balance the movement and stabilize the ball of the humerus within the shallow socket of the scapula.

However, repetitive stress, sudden injuries, or degenerative changes can lead to tendinitis, where the tendons become swollen and painful. This can significantly compromise shoulder function and range of motion, making everyday tasks difficult.

The condition is often diagnosed through a combination of patient history, physical examination, and imaging studies such as ultrasound or MRI, which may reveal inflammation, tendon thickening, or tears.

Rotator Cuff Tendinitis Symptoms

Rotator cuff tendinitis, also known as shoulder tendinitis, affects the tendons and muscles that help move the shoulder joint. When these tendons become inflamed or irritated, an individual can experience a range of symptoms, primarily focused around the shoulder area. Common symptoms include:

Pain and Tenderness

People with rotator cuff tendinitis often experience pain in the front of the shoulder, which may radiate down the side of the arm. There is usually tenderness when pressing on the outside of the shoulder.

Pain with Overhead Activities

Activities that require lifting the arm overhead can exacerbate pain, often making routine activities such as combing hair, reaching for objects on high shelves, or throwing a ball uncomfortable or painful.

Pain with Lying on the Affected Shoulder

The pressure of lying on the shoulder can increase pain, often interrupting sleep or making it difficult to lie on the affected side.

Decreased Range of Motion

Inflammation and pain can limit the range of motion, making it difficult to move the shoulder through its full range of movement.

Weakness

The shoulder may feel weak, especially when trying to lift objects or perform specific movements that involve the shoulder.

Swelling and Inflammation

Swelling in the shoulder due to inflammation can be another sign, though it might not always be visible externally.

Clicking or Cracking Sounds

People may hear or feel clicking or cracking sounds when moving their shoulder.

Stiffness

The shoulder might feel stiff, especially after periods of inactivity or rest.

Increased Pain at Night

Pain can become more noticeable at night, especially when rolling onto the affected shoulder during sleep.

If the condition progresses without treatment, the tendinitis may turn into a chronic issue, potentially leading to a rotator cuff tear, which can result in more severe pain and significant loss of function.

Thus, early recognition and management are essential to prevent progression and promote recovery. If these symptoms persist, it is advisable to seek medical attention to obtain a proper diagnosis and appropriate treatment plan.

Common Causes of Tendinitis in the Rotator Cuff

Tendinitis in the rotator cuff, also known as rotator cuff tendinitis or impingement syndrome, can occur for various reasons. The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint and allow for its wide range of motion. Here are some common causes of tendinitis in the rotator cuff:

Repetitive Stress

Repeating the same shoulder motions again and again can stress the rotator cuff muscles and tendons. This is common in jobs or sports that require frequent overhead reaching, lifting, or throwing, such as painting, swimming, baseball pitching, and tennis.

Overuse

Overusing the shoulder during activities that involve extensive or heavy lifting can lead to inflammation of the tendons.

Aging

As people age, their tendons become less flexible and more susceptible to injury. Rotator cuff tendinitis is more common in older adults due to the natural wear and tear of the tendons.

Injury

Acute injuries from falls or collisions can damage the rotator cuff tendons and lead to tendinitis.

Poor Posture

Long-term poor posture, especially with the shoulders chronically rounded forward, can lead to shoulder impingement and subsequent tendinitis.

Shoulder Impingement Syndrome

In this condition, the rotator cuff tendon is pinched between the shoulder bones. Over time, this can lead to inflammation and tendinitis.

Inadequate Warm-Up or Poor Conditioning

Not warming up before activity or having poor muscle conditioning can put extra stress on the tendons.

Weakness or Imbalance

Weak or imbalanced shoulder muscles can lead to incorrect shoulder movement patterns, causing increased stress on the rotator cuff.

Bone Spurs

Sometimes, bone overgrowths or spurs may develop on the bones in the shoulder, irritating or damaging the rotator cuff tendons during movement.

Genetic Factors

There may be genetic predispositions that affect the structure or blood supply of the rotator cuff tendons, leading to an increased risk of tendinitis.

Rotator Cuff Tear

Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear. Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief? Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do? If left untreated, full-thickness and 26% of partial-thickness tears will progress.

Calcific Tendonitis

Calcific tendonitis, also known as calcifying tendonitis, is a condition characterized by the formation of calcium deposits in a tendon, most commonly in the rotator cuff tendons of the shoulder. These deposits are not due to injury or trauma but rather occur spontaneously. Tendons, the thick connective tissues that link muscles to bones, aren’t usually calcified. However, in calcific tendonitis, calcium builds up in these tissues, which can result in inflammation and severe pain. This condition tends to occur more commonly in adults between 30 and 60 years old, and it’s more prevalent in women than in men.

Diagnosis and Evaluation

Diagnosing rotator cuff tendinosis typically involves a combination of a clinical examination and imaging tests. Here’s a step-by-step approach to how healthcare providers may diagnose the condition:

Medical history:

The doctor will begin by asking about symptoms, any recent injuries, activities or occupations that involve repetitive shoulder movements, and any history of shoulder problems.

Physical examination:

The doctor will examine the shoulder for tenderness and swelling and will assess the range of motion and strength of the shoulder joint. There are specific tests, like the Neer test and Hawkins-Kennedy test, that can provoke symptoms of rotator cuff tendinosis and help to localize the problem.

Diagnostic imaging, such as X-rays:

These can rule out other causes of shoulder pain such as arthritis or bone spurs that could be impinging on the tendon.

Diagnostic imaging, such as ultrasound:

This imaging modality is useful for assessing soft tissue structures like rotator cuff tendons. It can show changes in the tendon’s structure and is also useful for dynamic assessment (examining the shoulder while it’s moving).

Diagnostic imaging, such as MRI:

Magnetic resonance imaging (MRI) can provide detailed images of both the soft tissues and bones in the shoulder. It can show both acute injuries (like tears) and chronic conditions (like tendinosis) with changes in the tendon’s signal intensity that are characteristic of degeneration.

Additional tests:

Sometimes, further tests are needed if the diagnosis is still unclear or if there is a possibility of other conditions being present. This could include blood tests or diagnostic injections.

Getting an accurate diagnosis is key with shoulder conditions. Many times rotator cuff tears, tendinosis, and labral tears are found in completely asymptomatic shoulders.

Treatment Options for Rotator Cuff Tendinitis

Rotator cuff tendinitis, also known as rotator cuff tendinitis or shoulder tendinitis, is a common condition that causes pain and inflammation in the tendons of the rotator cuff muscles in the shoulder. Treatment options for rotator cuff tendinitis typically aim to reduce pain and inflammation and improve shoulder function. Here are some common treatment approaches:

Rest: Resting the affected shoulder is often the first step in treating rotator cuff tendinitis. Avoid activities that aggravate the condition, especially overhead movements or heavy lifting.

Ice: Applying ice to the shoulder for 15-20 minutes at a time, several times a day, can help reduce inflammation and relieve pain. Be sure to wrap the ice pack in a cloth to avoid direct skin contact.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation. Follow your doctor’s or pharmacist’s recommendations for proper use.

Physical therapy: A physical therapist can design an exercise program to improve shoulder strength and flexibility, as well as teach you techniques to correct your posture and prevent further injury. Therapists may also use modalities like ultrasound or electrical stimulation to aid in healing.

Shoulder exercises: Specific exercises targeting the rotator cuff muscles can help strengthen and stabilize the shoulder. Examples include pendulum exercises, scapular squeezes, and resistance band exercises. It’s essential to perform these exercises correctly to avoid further injury.

Corticosteroid injections: In some cases, your doctor may recommend corticosteroid injections into the shoulder joint to reduce inflammation and pain. These injections can provide temporary relief but are not a long-term solution.

Intramuscular stimulation (IMS): Also known as dry needling, this technique involves using needles to target and release trigger points or knots in the muscles. It can help relieve muscle tension and improve range of motion.

Extracorporeal shock wave therapy (ESWT): ESWT uses shock waves to stimulate blood flow and promote healing in the affected tendons. It is another option that may be considered when conservative treatments fail.
Surgery: If conservative treatments do not provide relief or if the tendon is severely damaged, surgical intervention may be necessary. Surgery can involve repairing the torn or damaged tendon, removing inflamed tissue, or decompressing the area around the rotator cuff.

Regenerative Options Available to Treat Rotator Cuff Tendinitis

In-office evaluations are best to diagnose rotator cuff tendinitis. Our expert physicians will spend ample amounts of time discussing all your symptoms, followed by a thorough hands-on examination, including testing all the nerves in the upper extremity, muscle testing, sensory testing, and specific exam maneuvers for different shoulder pathologies.

After a hands-on examination, we utilize diagnostic ultrasound to get more details about your rotator cuff. Musculoskeletal ultrasound is actually more specific compared to MRIs in identifying rotator cuff pathology!

Prolotherapy Injections

It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…

PRP Injections

PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…

Prognosis and Recovery

After a proper evaluation, our experts will review all data with you, including the anatomy, severity of the pathology, and, ultimately, your candidacy for an orthobiologic for your rotator cuff tendinitis.

Results can vary depending on the severity of the tendon, meaning very severe cases are likely to be poor candidates for PRP compared to mild and moderate cases, which are far better candidates. We will review the rehabilitation process, expectations, and timeline to get you back to enjoying life.

Heal Faster from Tendinitis Through Safe and Effective Treatments

You no longer have to accept that the only options are PT, steroids, and surgery. Over the last 20+ years, our physicians have dedicated themselves to improving orthopedic outcomes with safer alternatives such as PRP over steroids.

If you have been dealing with rotator cuff issues, failing to get results with conservative care but also wanting to avoid steroids and surgery, come in for an evaluation so one of our experts can discuss all the options to getting you back to the things you love.

Are you a Candidate?

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Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…