Rotator cuff tendonitis: Causes, Symptoms, and Treatment

Rotator cuff tendonitis is an inflammation in the area of the rotator cuff is one of the most common diseases of the shoulder and can be caused by various underlying diseases. The most common causes of inflammation in the area of the rotator cuff are

  • Impairment of the tendon sheaths
  • Bottleneck syndromes (impingement)
  • Traumatic changes in the bony structures of the shoulder joint
  • Tear in one of the muscles of the rotator cuff

Affected patients usually experience early, sharp, or pulling pain, which can radiate from the shoulder joint to the neck or upper arm.

Pain in shoulder and arm

Inflammation of the rotator cuff often causes swelling and redness. The usual range of motion of the shoulder joint is also typically limited in the presence of inflammatory processes.

Persons who experience sudden pain in the shoulder should take care of the joint immediately and consult a specialist as soon as possible. The development of complications and secondary diseases can only be effectively prevented by comprehensive diagnostics and the rapid initiation of appropriate therapy.

More about Calcified shoulder: Causes, Symptoms, and Treatment

Causes of rotator cuff tendonitis

Inflammation in the area of the rotator cuff can have a variety of reasons. In most cases, the inflammatory processes occur as a result of sustained irritation of the muscle or tendon tissue.

This tendon is most often inflamed

The tendon of the rotator cuff that is most frequently inflamed is the supraspinatus tendon. This tendon is an essential support for lifting the arm to the side and forward in healthy individuals. It is located between the acromion and the humeral head and is subject to enormous mechanical stress.

Signs of wear and tear, chronic overloading, and accidents can cause the tendon to become inflamed and even develop a hole and wear or tear.

Please check the information about Shoulder cartilage damage: Symptoms and Treatment

Calcified shoulder

Inflammation of the rotator cuff can be observed particularly frequently in persons suffering from the so-called calcified shoulder (tendinosis calcarea).

Calcified shoulder is a disease characterized by calcification of one or more tendons. In principle, such calcifications can affect any tendon in the human body, but they are particularly common in the shoulder area.

Calcified shoulder occurs most frequently in people between the ages of 40 and 50. It is assumed that degenerative changes in the tendons (i.e., age-related wear and tear) have a negative influence on the blood circulation in the tendons and thus limit their functionality.

The storage of calcium crystals is said to be a reaction to the lack of blood circulation. Inflammation of the rotator cuff cannot be observed in every patient suffering from a calcified shoulder. The inflammatory processes are mostly caused by the recruitment of immune cells.

More about Calcified shoulder: Causes, Symptoms, and Treatment

Frozen Shoulder

The so-called “frozen shoulder,” an inflammatory swelling and shrinkage of the joint capsule, can lead to inflammation in the area of the rotator cuff.

Frozen shoulder is usually caused by trauma directly affecting the joint. In rare cases, this disease can also occur spontaneously.

Read more about Frozen shoulder: Causes, Symptoms, and Treatment

Symptoms of rotator cuff tendonitis

When the rotator cuff is inflamed, the five typical signs of inflammation can usually be observed.

Even at the beginning of the disease, affected patients feel stabbing or pulling pain in the area of the shoulder joint. Depending on the extent of the disease, this pain can radiate into the neck or upper arm.

Slightly pronounced inflammatory processes of the rotator cuff usually only cause movement-related complaints. Under resting conditions, the affected patients are often pain-free. Only when the inflammation spreads can pain at rest be observed.

Furthermore, local swelling of the soft tissue is one of the typical signs of inflammation.

In the case of an inflammation at the rotator cuff, the skin surface of the shoulder region also often appears reddened. In a side-by-side comparison, the affected shoulder typically shows significant overheating.

The usual range of motion of the shoulder joint can also be significantly restricted in the presence of an inflammation of the rotator cuff.

This pain is indicative of an inflammation of the rotator cuff

An inflammation of the rotator cuff is accompanied by characteristic symptoms. Severe shoulder pain occurs, which

  • occurs mainly when lifting, spreading, and turning the arm inwards.
  • occur at night, especially when lying on your side.
  • can radiate into the arm.
  • intensify when spreading the arm at an angle of 60 to 120°.

Please check the information about Shoulder cartilage damage: Symptoms and Treatment

Diagnosis of rotator cuff tendonitis

The diagnosis of suspected rotator cuff inflammation comprises several steps.

Probably the most important step is the detailed doctor-patient consultation (anamnesis). During this discussion, the patient should describe the symptoms he/she has experienced as precisely as possible.

In this context, the intensity, quality, and exact localization of the pain are of decisive importance.

Also, possible radiation of pain and accompanying symptoms can provide a first indication of the underlying disease.

Following the doctor-patient consultation, an orienting examination of both shoulders in a side comparison is usually carried out. During this examination, the shoulder region is inspected for skin symptoms (for example, redness and scars). The coarse temperature of the shoulders is checked in a side comparison. In this way, overheating typically of an inflammation of the rotator cuff can be detected.

The scope of movement of both shoulders is then checked. In the case of an inflammation of the rotator cuff, the inner and outer rotation, as well as abduction and adduction on the affected side, are shown to be restricted. Besides, moving the arm in some axes can lead to provocation of pain.

Further diagnostics in case of suspected inflammation of the rotator cuff are carried out using various imaging techniques. In particular, the preparation of an X-ray image in two planes is suitable for excluding bony injuries.

Computer tomography (CT) and magnetic resonance imaging of the shoulder joint (MRI of the shoulder) can also help to confirm the diagnosis and determine the extent of the disease.

Read more aboutBicep Tendonitis: Causes. Symptoms, and Treatment

Therapy of rotator cuff tendonitis

The treatment of an inflammation in the area of the rotator cuff depends largely on the underlying condition.

Without the occurrence of possible complications, conservative treatment is indicated.

Painkilling medications that also have an anti-inflammatory effect are well suited for the treatment of an inflammation of the rotator cuff.

The affected shoulder must be immobilized during an acute inflammation.

Cooling compresses, and cooling pads can be used to relieve the pain and counteract the swelling.

Patients who suffer from inflammatory processes on the rotator cuff at regular intervals often require surgical treatment. This is particularly the case in calcification-related inflammation with calcification foci larger than 1 cm.

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When do you need cortisone?

The injection of a cortisone preparation may be indicated in cases of pronounced inflammation of the rotator cuff to promote the healing process. This is not a routinely performed treatment method. However, patients with severe or chronic inflammation of the rotator cuff can often benefit from cortisone injections.

This involves injecting cortisone locally into the affected shoulder.

Which exercises help in the case of a rotator cuff tendonitis

During an acute inflammation of the rotator cuff, it is important to protect the affected shoulder to ensure healing and the course of the disease. Once the inflammation has subsided, targeted physiotherapy can be helpful. Exercises with a rope pull that mobilize the shoulders are suitable for this.

A simple exercise is to pull the shoulder downwards against resistance. For this, you can use a Theraband and attach it to the top of the door.

Another possible exercise is arm swinging with weight. This promotes the formation of synovial fluid in the shoulder joint. For this, I use a lightweight, for example, a water bottle, let the arm hang down and swing the shoulder slowly forward and backward.

To center the shoulders, you can take a weight in each hand and pull the shoulders upwards.

After the exercises, you should stretch your shoulder. To do this, you can, for example, lean against the wall, pull the shoulder blades backward and then relax. Tilt your head alternately to one side and stretch your arm to the other side.

Check our article about Rotator cuff tendonitis: Causes, Symptoms, and Treatment

Taping the shoulder

To immobilize the affected shoulder and relieve pain, the affected shoulder can be taped. The tape must be applied correctly. For a start, it can be helpful to have the tape applied by an experienced physiotherapist. When the tape is applied correctly, it can

  • Release tensions,
  • Relieve pain
  • Fx the shoulder

The tape can remain on the skin for up to seven days.

When can you start exercising again?

An inflammation of the rotator cuff requires physical protection and immobilization of the joint. Depending on the cause, the inflammation heals at different rates. To prevent inflammation, for example, bursitis, from becoming chronic, it is important to take the disease seriously at an early stage and let it heal.

Normally, an inflammation of the rotator cuff heals within a few weeks. Only when the patient is completely free of symptoms may he/she return to sports.

Please check more about Biceps tendon tear: Causes, Symptoms, and Treatment

Therapy of a calcified shoulder

If the inflammation in the area of the rotator cuff is based on tendon calcification (see also: calcified shoulder), the treatment is usually carried out by using the so-called extracorporeal shock wave therapy (ESWT for short). In this procedure, the calcifications in the tendon are exposed to shock waves, which can destroy the calcifications.


The prognosis in case of inflammation in the area of the rotator cuff depends mainly on the underlying disease and the extent of the inflammatory processes.

In this context, affected patients should note that an optimal healing process can only be guaranteed if the shoulder joint is immobilized immediately after the onset of pain.

Furthermore, serious complications can only be avoided if a suitable therapy is initiated early on. Under ideal conditions, however, the prognosis of an inflammation in the area of the rotator cuff is quite good.

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