The rotator cuff muscles are a group of 4 muscles that attach the humerus (upper arm bone) to the scapula (shoulder blade). The rotator cuff muscles help raise, rotate, and stabilize the upper arm. A tendon is a bundle of fibers that connects the muscles to the bone. Rotator cuff tendinitis occurs when the tendon connected to the rotator cuff muscles becomes inflamed and irritated. The condition can be caused by:

• Repetitive arm movements, such as those performed by a hairstylist or house painter.
• Overhead shoulder motions, such as those performed by baseball pitchers or swimmers.
• Weakness and muscle imbalances in the shoulder blades and shoulder muscles.
• Tight muscles and tissues around the shoulder joint.
• Bony abnormalities of the shoulder region that cause the tendons to become pinched.
• Poor posture, such as rounded shoulders caused by leaning over a computer for long periods (shoulder impingement syndrome).

Rotator cuff tendinopathy is characterized by shoulder pain that can occur gradually over time or start quite suddenly. The pain occurs in the shoulder region and sometimes radiates into the upper arm. It does not usually radiate past the elbow region, although it can. You may be symptom free at rest or experience a mild, dull ache; however, pain can be moderate to severe with certain shoulder movements and can be easily provoked. Reaching behind the body to perform a motion, as in fastening a seat belt, can be very painful. So can overhead activities, such as throwing, swimming, reaching into a cupboard, or combing your hair. The pain can worsen at night, especially when rolling over or attempting to sleep on the painful side. You may notice weakness when lifting and reaching for household items. Holding a heavy platter or taking a pan off the stove may become difficult. If the condition is left untreated, it is possible to begin to experience pain in other areas, such as the neck. 

A physical therapist will perform an evaluation and ask you questions about the pain and other symptoms you are feeling. Your physical therapist may perform strength and motion tests on your shoulder, ask about your job duties and hobbies, evaluate your posture, and check for any muscle imbalances and weakness that can occur between the shoulder and the scapular muscles. Your physical therapist will gently touch your shoulder in specific areas to determine which tendon or tendons are inflamed, and may perform other special tests to detect rotator cuff tendinopathy. Generally, a physical examination is all that is needed to diagnose rotator cuff tendinopathy. If the symptoms do not resolve with physical therapy, imaging (such as an MRI) may be considered, to help determine any possible underlying condition that could be affecting the shoulder.

It is important to get proper treatment for tendinitis as soon as it occurs. Over time, a degenerated tendon that is not treated can begin to tear, causing a more serious condition. Physical therapy can be very successful in treating rotator cuff tendinitis, tendinosis, and shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

Pain management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, massage, or moist heat may be applied for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically-charged patch) and electrical stimulation (TENS) may be applied.

Patient education. Posture education is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become pinched. Your physical therapist may suggest adjustments to your workstation and work habits. Your physical therapist will also instruct you in ideal sitting, standing, and sleeping positions to help alleviate symptoms. Your therapist may suggest different ways to perform currently painful activities and show you movements to avoid while the shoulder is painful.

Manual therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches, to get your shoulder moving again in harmony with your shoulder blade.

Range-of-motion exercises. You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.

Strengthening exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program, so you can continue rotator-cuff and shoulder-blade strengthening long after you have completed your formal physical therapy.

Functional training. As your symptoms improve, your physical therapist will help you return to your previous level of function, which may include household chores, job duties, and sports-related activities. Functional training can include working on lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics. You and your physical therapist will decide what your goals are, and get you back to your prior level of functioning as soon as possible.

The likelihood of developing rotator cuff tendinopathy can be reduced by:

• Being aware of repetitive movements that may lead to pain—especially over your head, across your body, or behind your back—and modifying your activity if there are any symptoms of discomfort.
• Maintaining ideal shoulder and spinal posture during daily activities, including sitting at a computer. This can be accomplished by:
  • Performing daily stretches to the shoulder and upper back to maintain normal movement. Tightness in the upper back, or a rounded shoulder posture will decrease the ability to move your torso, and that makes the shoulder have to work harder to perform everyday activities, such as reaching for objects.
  • Keeping your upper body strong, including the upper back and shoulder-blade muscles, will help prevent tendinitis. Many people work the muscles in their chest, arms, and shoulders, but it is also important to work the muscles around the shoulder blade and upper back. These muscles provide a strong foundation for your shoulder function. Without a strong foundation, muscle imbalances occur and put the shoulder at risk for injury.

All physical therapists are prepared through education and experience to treat rotator cuff tendinitis. However, you may want to consider:

• A physical therapist who is experienced in treating people with rotator cuff tendinitis. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you are looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, or other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people who have rotator cuff tendinitis.
• Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.