Rotator Cuff Tendonitis

Aka: Rotator Cuff Tendonitis, Rotator Cuff Tendinitis, Rotator Cuff Tendinopathy, Shoulder Impingement, Subacromial Bursitis, Subdeltoid Bursitis

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II. Course

  1. Step 1: Small cuff tears from repetitive use injury (Athlete, Heavy Laborer)
  2. Step 2: Tendon scarring and thickening
  3. Step 3: Secondary irritation of overlying bursa
  4. Step 4: Thickened tendon and bursa (decreases sub-acromial space)
  5. Step 5: Impingement pain and crepitus (Provoked with abduction)

III. Symptoms

  1. Pain worse at night
  2. Shoulder tenderness and atrophy
  3. Unable to lie on affected Shoulder
  4. Locking Sensation with abduction
  5. Referred pain to deltoid
  6. Patient automatically turns palm up on abduction
    1. Externally rotates Shoulder
    2. Gives Rotator Cuff more room
  7. Active "palm down" abduction is painful

IV. Signs

  1. Supraspinatus insertion maximally tender
  2. Acromioclavicular Joint Pain from degenerative disease
  3. Muscle Strength intact
  4. Pain and crepitation
    1. Pain worse between 60 to 120 degrees abduction
    2. Soft tissue maximally compressed in subacromial space
  5. Shoulder Impingement Signs
    1. See Shoulder Evaluation

V. Imaging: Shoulder XRay

  1. Sclerosis at tuberosity may be seen
  2. Hook Acromion (Types 2-3) associated with impingement

VI. Differential Diagnosis

  1. Rotator Cuff Rupture
  2. Rotator Cuff Calcification

VII. Management: General

  1. Relative Rest (avoiding overuse while maintaining range of motion)
    1. Avoid complete rest especially in older patients
      1. Risk of Frozen Shoulder
    2. Avoid excessive use
    3. Avoid all overhead work
    4. Sling for very limited time if necessary
  2. General Measures
    1. NSAIDs
    2. Moist heat applied 4 times daily
  3. Subacromial Corticosteroid Injection
    1. Corticosteroid Injection at subacromial space
  4. Physical Therapy
    1. Local Ultrasound or Diathermy
    2. Phonophoresis (Ultrasound with Cortisone Cream)
  5. Exercise
    1. Shoulder Range of Motion Exercises
  6. Workplace
    1. Avoid Shoulder flexion and abduction between 90 and 120 degrees
    2. Avoid overhead work

VIII. Management: Surgery

  1. Reserved for cases failing conservative treatment
  2. Procedures
    1. Partial acromion excision
    2. Release of obstructive soft tissue
    3. Repair of Rotator Cuff Tears
  3. Efficacy
    1. At 2 years, patients without surgery improve significantly with conservative management (e.g. physical therapy)
    2. No significant added benefit to Shoulder Impingement surgery over routine care
    3. Kanto (2025) BMJ 391:e086201 [PubMed]

IX. Prognosis

  1. Anticipate improvement in 3 to 5 weeks
  2. Delayed improvement suggests Rotator Cuff Rupture

X. References

  1. Burbank (2008) Am Fam Physician 77:493-7 [PubMed]
  2. Childress (2013) Am Fam Physician 87(7): 486-90 [PubMed]
  3. Mantone (2000) Orthop Clin North Am 31:295-311 [PubMed]

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