Do you have pain at the tip of your shoulder when raising your arm overhead? Is it a pinching pain that is getting worse over time and just won’t go away?
What about pain while lying on your side? Does that pressure on your shoulder hurt?
Do you struggle to reach behind you, put something in your back pocket, wash your upper back, or reach something way up in the top cabinet?
All of these things may be due to a tendon injury in the shoulder called rotator cuff tendonitis.
The rotator cuff is often this ambiguous word that most people don’t understand the meaning of or how to say it. I’ve heard people say rotator cup and they know it has to do with the shoulder, but nothing more.As a physical therapist, I’ll say that most rotator cuff tendon issues do not get better with time. Often they’re complicated and may be associated with other pathologies nearby of the biceps, bursa, or bones in the shoulder. The shoulder joint is complicated, so let’s dive deeper into the rotator cuff so you better understand it. (See Related: About Me)
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What is rotator cuff tendonitis?
Rotator cuff tendonitis is an overuse injury to the one or more of the four muscles that surround the scapula (shoulder blade) front and back.
The muscle that most commonly gets injured is the top one - the supraspinatus.
What often happens is there can be overuse or microtrauma as a result of repetitive activity, but it can also be something that builds up over time.
Some common symptoms include feeling a throbbing pain, a popping or catching when the arm rotates, pain lying on that shoulder, possible radiating pain down into the arm, possible swelling, pain raising the arm out to the side or overhead (called a painful arc), and muscle guarding of the arm.
Common Causes of Rotator Cuff Tendonitis
The three most common causes of rotator cuff tendonitis are repetitive overhead movements, having other nearby shoulder injuries, and your shoulder anatomy.
The most common cause of rotator cuff tendonitis is repetitive movements especially overhead. Picture a tennis player serving the ball over and over. That repetitive movement often leads to rotator cuff tendonitis. So people who are pitchers, racquet players, or swimmers are more prone to this injury.
In addition, other nearby injuries can also greatly impact the rotator cuff. For example, a shoulder impingement and/or shoulder bursitis often coexist with rotator cuff tendinopathy or tears because they’re in close proximity at the shoulder. Another injury that is common when the rotator cuff is weak is a shoulder laxity, dislocation, or subluxation where the humerus moves too much and even dislocates causing a rotator cuff injury or tear.
Our posture can impact things as well. Having a more rounded, kyphotic posture can lead to more impingement at the shoulder leading to more shoulder injuries. It leads the posterior (back) scapular muscles to often be weaker.
Lastly, the anatomy of the shoulder makes many of us more prone to shoulder impingement and tendon injury. Why? Well the head of the humerus (the large upper arm bone) likes to migrate upward, especially if we have a weak rotator cuff. In addition, osteophytes (bone spurs) often form on the acromion and degenerative joint disease is also common there. This leads to impingement (pinching) of the rotator cuff, especially the supraspinatus.
Location & Muscles Affected by Rotator Cuff Tendonitis
These are the four muscles that make up the rotator cuff:
Supraspinatus: top of the scapula
Infraspinatus: back of the scapula
Subscapularis: front of the scapula
Teres Minor: back of the scapula
Testing for Rotator Cuff Tendonitis
Testing for rotator cuff tendonitis typically begins in Physical therapy with some range of motion (ROM) tests, manual muscle selective tissue tensioning tests (testing tendon strength), muscle length tests (testing flexibility), manual muscle testing, palpation tests, and special tests.
How to Test Rotator Cuff Tendonitis: The majority of tests for the rotator cuff require two people. I recommend that if you suspect a rotator cuff injury, you visit you Physician or Physical therapist for proper testing. Some of the common tests done for the rotator cuff include:
Typical test results: tenderness to palpation near the origin or insertion, decreased and painful flexibility, decreased active range of motion, muscle imbalances, strong but painful tendon strength testing, decreased strength (for the one or more of the four muscles), and possible swelling.
The rotator cuff muscles do these 3 main actions: shoulder abduction, shoulder external rotation (ER), and shoulder internal rotation (IR). Note: the teres minor also assists with adduction.
Rotator cuff tendonitis is often easily diagnosable with the tests above. So from there, it’s typically suggested you perform 6-8 weeks of Physical therapy. Then if there is no improvement, your Physician may suggest further testing like getting an Xray, MRI, or ultrasound to determine if there is more extensive damage like a partial tear, full tear, calcification, or more.
Conservative Treatment for Rotator Cuff Tendonitis
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Now that you better understand what rotator cuff tendonitis is, what causes it, and which muscles are involved let’s now cover what you’re likely most interested learning about: treatment for rotator cuff tendonitis.
Physical therapy treatment should always be 100% customized to you: the stage of your injury (recent/acute or chronic), your history, your activity level, your job, your impairments, your abilities, and your goals.
With that said, the below treatments are general treatments often prescribed by Physical therapists for rotator cuff tendonitis, including many exercises for rotator cuff tendonitis. Always consult your Physician before beginning any new exercise program.
Treatments for rotator cuff tendonitis (from basic to advanced):
Rest (less or modified repetitive aggravating activity)
Joint mobilization (level depends on stage of injury; plus mobilization with movement (MWM))
Range of motion exercise (without a pain-free range) like Pendulums (see Video)
Stretching (plus contract-relax technique)
Strengthening exercise (including isometrics)
Manual/Massage: soft tissue massage, deep tissue massage, cross friction massage (if not an acute injury), dry needling
Modalities: Ice, Ultrasound
Postural education (less rounding, forward shoulder posture)
Sling (if prescribed and more severe)
If those conservative treatments don’t help then PRP injections, corticosteroid injections, or even surgery may be needed (especially if there are other tears or injuries included).
Below are some products from Amazon that are often useful for addressing rotator cuff tendonitis pain:
Physical Therapy Exercises for Rotator Cuff Tendonitis
In the following videos, I share how to test for rotator cuff tendonitis, how to feel for tenderness, how to improve range of motion for the shoulder, how to stretch the shoulders, how to improve shoulder mobility, and finally some strengthening exercises for rotator cuff tendonitis.
How to Palpate for Rotator Cuff Tendonitis
Stand with your palm facing forward on your dominant arm. Now bend your arm and tense it as if you’re squeezing a pencil in your armpit region. With your other hand, feel your scapula. Grip it hard and you can pinch grip the front and back of the scapula at the same time. You’re now likely feeling the infraspinatus, subscapularis, and teres minor. Finally, the supraspinatus can’t as easily be felt because it lies underneath the upper trap. But you can feel the upper trap muscle off to the side of the neck and the supraspinatus is underneath that.
Then to feel the rotator cuff tendons where they insert or attach out at the upper humerus, you can feel the bony outer shoulder region and then move down from there about an inch.
Palpating for Rotator Cuff Tendonitis
Mobility Exercises for Rotator Cuff Tendonitis
Grab a stick, broomstick, yard stick, or golf club and try them out!
Range of Motion and Stretching for Rotator Cuff Tendonitis
Grab a stick, broomstick, yard stick, or golf club and try them out!
Strengthening Exercises for Rotator Cuff Tendonitis
Grab a long band and some light dumbbells and try them out!
Mission: Mobilize, Modify, Move
It’s my goal to ensure you learn three things with every blog post: how to mobilize your body, how to modify exercise, and how to optimize your movement.
Above I shared a video for dynamic shoulder mobility and stretching. I also shared some great rotator cuff strengthening and shoulder stability exercises. Strengthening the shoulder helps stimulate blood flow to the muscle to help speed up the healing process.
Now, let’s cover some ideas for how to modify exercise if you have rotator cuff tendonitis:
Consider adjusting your workout split to focus more on the lower body and core more often temporarily until your shoulder and elbow feel better.
Modify upper body exercises by working within a comfortable range of motion, using lighter loads, slowing things down, and adjusting your grip. For example, a thumbs down or palm down grip may be uncomfortable for you, but a thumbs up grip may feel better.
Throughout the day, modify any of the overhead repetitive movements you make as that’s possibly the true cause of the inflammation.
Finally, if you plan to continue to strength train, I suggest you try these things out to move more optimally:
Warm-up appropriately prior to lifting. Try using a band to do some light, high rep lateral raises, shoulder ERs, shoulder IRs, and serratus work.
During strengthening exercises, an eccentric-accentuated focus is shown to be effective for tendonitis.
Definitely modify or skip these exercises temporarily: overhead press, bench press, and holding a barbell on your upper back. An easy substitution for overhead presses would be to switch to an incline press instead. So instead of working at 170-180 degrees of overhead shoulder flexion, you can work at around 120-130 degrees of flexion which may be more comfortable for you.
If any of what I said is confusing or you want additional help with addressing your impairments, be sure to watch the webinar “Outsmart your Injury” to learn more about exercise modification and how you can take control of your injury instead of letting it control you. Then reach out and let’s chat!
Thanks for reading!
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