Rotator Cuff Tendinitis

Rotator cuff tendinitis (also called rotator cuff tendinopathy) is pain and irritation of the rotator cuff tendons, the four tendons that cover the ball of the shoulder and help lift and rotate the arm. It is a common cause of shoulder pain in active adults and overhead athletes, and it often occurs together with bursitis and shoulder impingement. Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats rotator cuff tendinitis primarily without surgery.

Causes

• Repetitive overhead activity, such as swimming, throwing, tennis, volleyball, weightlifting or overhead work
• A sudden increase in training load or a new activity
• Weakness or poor control of the shoulder-blade (scapular) muscles and posture
• Age-related changes in the tendon, which become more common after 40

Symptoms

• Aching at the front or outside of the shoulder, sometimes spreading down the upper arm
• Pain when lifting the arm overhead or out to the side, or reaching behind the back
• Pain at night, especially lying on the affected side
• Weakness that is usually due to pain rather than a tear

Diagnosis

Dr. Dold examines your shoulder motion and strength, tests the rotator cuff and checks the neck, the biceps tendon and the AC joint. X-rays can show bone spurs or calcium in the tendon (see calcific tendinitis). An ultrasound or MRI is used when a tear is suspected or symptoms do not improve. Tendon changes are common on MRI even in people without pain: 34% of people with no shoulder symptoms had a rotator cuff tear on MRI in one study,¹ so imaging is matched to your examination. If a tear is found, see partial-thickness rotator cuff tears or rotator cuff tears.

Treatment

Clinical practice guidelines consistently recommend an active exercise program as the main treatment, with pain medicine and cortisone injections as options to reduce pain.²

• Relative rest and activity changes: reduce the painful overhead or loaded activity for a period, without stopping all movement
• Physical therapy: progressive strengthening of the rotator cuff and shoulder-blade muscles, posture and technique work. A systematic review supported loaded exercise for improving pain and function.³
• Anti-inflammatory medicine, if safe for you²
• Injections: a cortisone injection into the bursa can calm pain so you can progress with therapy.² Another option is platelet-rich plasma (PRP): in a randomized trial of patients with tendinopathy or partial tears, PRP improved pain and function more than cortisone at 3 months, although results were similar at 12 months.⁴
• Return to sport or work: a gradual return, with attention to training load and technique

Is surgery needed?

Rarely, for tendinitis alone. In a large UK randomized trial (CSAW), arthroscopic subacromial decompression offered no additional benefit over a placebo (diagnostic-only) arthroscopy for patients with subacromial pain and an intact rotator cuff.⁵ A Finnish placebo-controlled trial (FIMPACT) found no benefit of decompression over placebo surgery or exercise therapy at 10 years.⁶ For this reason, Dr. Dold focuses on non-surgical treatment and considers surgery mainly when there is another problem, such as a rotator cuff tear, a biceps tendon problem or AC joint arthritis, or when symptoms persist despite a complete course of treatment.

What the research shows

Rotator cuff tendinitis (often called rotator cuff-related shoulder pain) has been studied in dozens of trials. Here is what they show.

Exercise is the foundation

Reviews of the evidence strongly recommend exercise as first-line treatment, and specific shoulder exercises outperform generic ones. Strengthening, especially progressive loading, ranks highly in recent analyses. Interestingly, the large GRASP trial found that a single advice session with a physiotherapist worked about as well as a longer supervised exercise program over 12 months.

Injections

Cortisone injections relieve pain in the short term, usually for several weeks, but have not shown long-term benefit in large trials. Ultrasound guidance may improve accuracy and short-term relief modestly. Several randomized trials suggest PRP may give longer-lasting improvement than cortisone, though study methods vary and the evidence is not yet definitive.

Other treatments

Manual therapy may help pain when added to exercise. Treatments such as therapeutic ultrasound, laser and kinesiology tape have weak supporting evidence.

Why see Dr. Dold

• Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
• Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
• Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
• Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
• Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
• D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Frequently asked questions

Research cited on this page

1. Sher JS, Uribe JW, Posada A, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10-15. PubMed
2. Doiron-Cadrin P, Lafrance S, Saulnier M, et al. Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations. Arch Phys Med Rehabil. 2020;101(7):1233-1242. PubMed
3. Littlewood C, Ashton J, Chance-Larsen K, et al. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012;98(2):101-109. PubMed
4. Kwong CA, Woodmass JM, Gusnowski EM, et al. Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial. Arthroscopy. 2021;37(2):510-517. PubMed
5. Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-338. PubMed
6. Kanto K, Bäck M, Ibounig T, et al. Arthroscopic subacromial decompression versus placebo surgery for subacromial pain syndrome: 10 year follow-up of the FIMPACT randomised, placebo surgery controlled trial. BMJ. 2025;391:e086201. PubMed
7. Pieters L, Lewis J, Kuppens K, et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther. 2020;50(3):131-141. PubMed
   An overview of systematic reviews made a strong recommendation for exercise therapy as first-line treatment for subacromial shoulder pain, with manual therapy as an add-on.
8. Steuri R, Sattelmayer M, Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017;51(18):1340-1347. PubMed
   A meta-analysis found exercise reduced pain more than non-exercise controls, and specific shoulder exercises more than generic ones.
9. Zhang W, Du M, Xia L, et al. Effects of seven types of exercise in the treatment of rotator cuff-related shoulder pain (RCRSP): a systematic review and Bayesian network meta-analysis. J Orthop Surg Res. 2025;20(1):1075. PubMed
   A 2025 network meta-analysis of 15–16 trials found concentric strengthening ranked highest for improving shoulder pain and function.
10. Pavlova AV, Shim JSC, Moss R, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. Br J Sports Med. 2023;57(20):1327-1334. PubMed
    A meta-analysis of 110 tendinopathy studies found higher-intensity resistance programs tended to give larger improvements.
11. Cooper K, Alexander L, Brandie D, et al. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technol Assess. 2023;27(24):1-389. PubMed
    A review supported combining exercise with other conservative care and mixing eccentric and concentric strengthening for rotator cuff pain.
12. Heron SR, Woby SR, Thompson DP. Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy. 2017;103(2):167-173. PubMed
    A randomized trial found open-chain, closed-chain and range-of-motion exercises all improved short-term pain and disability.
13. Hopewell S, Keene DJ, Marian IR, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet. 2021;398(10298):416-428. PubMed
    The large GRASP trial (708 patients) found a progressive exercise program was not better than a single physiotherapist advice session, and a cortisone injection gave no long-term benefit.
14. Zhong Z, Zang W, Tang Z, et al. Effect of scapular stabilization exercises on subacromial pain (impingement) syndrome: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2024;15:1357763. PubMed
    A review found scapular stabilization exercises reduced pain and improved function in subacromial pain.
15. Desjardins-Charbonneau A, Roy JS, Dionne CE, et al. The efficacy of manual therapy for rotator cuff tendinopathy: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2015;45(5):330-50. PubMed
    A meta-analysis found manual therapy may reduce pain in rotator cuff tendinopathy, but its effect on function was unclear.
16. Page MJ, Green S, McBain B, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016;2016(6):CD012224. PubMed
    A Cochrane review found only one high-quality trial comparing manual therapy plus exercise with placebo, and it showed no clinically important difference.
17. Hsieh LF, Kuo YC, Huang YH, et al. Comparison of corticosteroid injection, physiotherapy and combined treatment for patients with chronic subacromial bursitis – A randomised controlled trial. Clin Rehabil. 2023;37(9):1189-1200. PubMed
    In a randomized trial, cortisone injection with or without physiotherapy relieved symptoms faster than physiotherapy alone, but recurrence was lowest with physiotherapy alone.
18. Lin MT, Chiang CF, Wu CH, et al. Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2019;100(2):336-349.e15. PubMed
    A network meta-analysis found cortisone helps in the short term (3–6 weeks) but not beyond 24 weeks, while PRP and prolotherapy may help longer.
19. Deng X, Zhu S, Li D, et al. Effectiveness of Ultrasound-Guided Versus Anatomic Landmark-Guided Corticosteroid Injection on Pain, Physical Function, and Safety in Patients With Subacromial Impingement Syndrome: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2022;101(12):1087-1098. PubMed
    A meta-analysis of 12 randomized trials found ultrasound-guided cortisone injections relieved pain somewhat more than landmark-guided injections.
20. Bloom JE, Rischin A, Johnston RV, et al. Image-guided versus blind glucocorticoid injection for shoulder pain. Cochrane Database Syst Rev. 2012(8):CD009147. PubMed
    An earlier Cochrane review found no clear advantage of ultrasound-guided injections over standard injections.
21. Rossi LA, Brandariz R, Gorodischer T, et al. Subacromial injection of platelet-rich plasma provides greater improvement in pain and functional outcomes compared to corticosteroids at 1-year follow-up: a double-blinded randomized controlled trial. J Shoulder Elbow Surg. 2024;33(12):2563-2571. PubMed
    In a randomized trial of young adults with rotator cuff tendinopathy, one PRP injection gave better pain and function at 12 months than one cortisone injection.
22. A Hamid MS, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251111. PubMed
    A meta-analysis of PRP for rotator cuff tendinopathy found varied preparation methods and mixed results.
23. Masiello F, Pati I, Veropalumbo E, et al. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood Transfus. 2023;21(2):119-136. PubMed
    A meta-analysis of ultrasound-guided PRP injections for tendon disorders found lower pain scores than controls at up to 6 months, with low-certainty evidence.
24. Page MJ, Green S, Mrocki MA, et al. Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev. 2016;2016(6):CD012225. PubMed
    A Cochrane review found only low-quality evidence for electrotherapy treatments such as ultrasound and laser in rotator cuff disease.
25. Williams S, Whatman C, Hume PA, et al. Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness. Sports Med. 2012;42(2):153-64. PubMed
    A meta-analysis found little quality evidence that kinesiology tape is better than other elastic tape for sports injuries.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.