Pathophysiology

Irritation of the rotator cuff tendon is one of the most common causes of shoulder pain. Tendinopathy is an umbrella term that covers a number of conditions that present and respond to treatment in similar ways. Often tendinopathy follows a period of overload or trauma, such as a strain or prolonged compression. Rotator cuff tendinopathy is often the correct diagnosis in misdiagnosed frozen shoulders.

Tendinopathy results in the tendon becoming painful, this can either be intermittent following certain movements or loads or constant in some cases. Often there will be little pain at rest or when doing activities with a tendinopathy, but you may experience your symptoms later the same day or the next day. This is normal in tendinopathy.

Symptoms

• Pain generally at the front and side of the shoulder
• Can be after trauma, compression or overuse (overload)
• Can come on slowly over time or quickly
• Pain in certain positions or following activity/exercise
• Limitations in function e.g. putting on coat, reaching behind your back or brushing hair
• Inability to lie on the shoulder
• Painful in the second half of the night

Management

• Activity modification
• Ice and/or heat
• Pain relief or anti-inflammatory medication as advised by your health professional
• A graded exercise programme is the best evidenced initial treatment in managing rotator cuff tendinopathy – it can take several months to improve
• Injections can be considered if exercise is not helpful
• Surgery is normal only a consideration if other treatments are not successful

Investigations

• In some cases ultrasound or magnetic resonance imaging can be useful, these are only considered if it will guide treatment
• Your GP may consider blood tests