Rotator cuff tendinosis is a common yet often misunderstood shoulder condition that can cause significant pain and limit your ability to perform daily activities. Unlike tendinitis, which is an acute inflammation of the tendon, tendinosis refers to the chronic degeneration of the tendon tissue, typically due to overuse or aging.
Let’s break down what rotator cuff tendinosis is, its causes and symptoms, and the most effective treatment strategies we employ at our Harlem and Morningside Heights physical therapy locations to help you regain shoulder function and reduce pain.
Understanding Rotator Cuff Tendinosis
What Is the Rotator Cuff?
The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and allowing a wide range of movements. These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. When these tendons become overworked or suffer from repetitive stress, it can lead to degeneration and weakness, a condition known as rotator cuff tendinosis.
How Common Is Rotator Cuff Tendinosis?
Rotator cuff tendinosis is a prevalent condition, especially among middle-aged and older adults. According to the American Academy of Orthopaedic Surgeons, approximately 2 million people in the United States seek medical treatment for rotator cuff problems each year. It is estimated that around 30% of individuals over the age of 50 have some degree of rotator cuff tendinopathy, which includes both tendinosis and tendinitis.
Causes of Rotator Cuff Tendinosis
Rotator cuff tendinosis is typically caused by repetitive shoulder movements or sustained overhead activities. Here are some common contributing factors:
- Repetitive Overuse: Activities that involve repetitive overhead motions, such as painting, swimming, or playing tennis, can lead to tendon wear and tear over time.
- Aging: As we age, the tendons naturally lose elasticity and become more prone to degeneration.
- Poor Posture: Prolonged periods of poor posture, such as slouching or forward head posture, can place undue stress on the shoulder tendons.
- Shoulder Impingement: When the tendons of the rotator cuff are pinched or compressed, it can lead to inflammation and degeneration.
- Previous Injuries: A history of shoulder injuries, such as dislocations or strains, can increase the risk of developing tendinosis.
Symptoms of Rotator Cuff Tendinosis
The symptoms of rotator cuff tendinosis can vary, but they typically include:
- Dull, Aching Pain: Pain is usually felt deep in the shoulder and may extend down the arm. It often worsens with overhead activities or at night.
- Weakness: You may experience weakness in the affected arm, especially when lifting objects or reaching overhead.
- Reduced Range of Motion: Stiffness and limited shoulder mobility can make it difficult to perform daily tasks, such as reaching behind your back or combing your hair.
- Cracking or Popping Sensation: You may feel or hear a crackling sensation when moving the shoulder.
If left untreated, rotator cuff tendinosis can progress to a tear, which may require more invasive treatments.
Diagnosing Rotator Cuff Tendinosis
If you suspect you have rotator cuff tendinosis, it’s important to seek a professional diagnosis. A healthcare provider, such as a physical therapist or orthopedic specialist, will typically perform a thorough evaluation, which may include:
- Medical History and Physical Examination: Discussing your symptoms, activity level, and any previous injuries, followed by a series of physical tests to assess shoulder strength and range of motion.
- Imaging Tests: X-rays or MRI scans may be used to rule out other conditions, such as fractures or tears, and to assess the severity of the tendon degeneration.
Treatment Options for Rotator Cuff Tendinosis
The good news is that most cases of rotator cuff tendinosis can be effectively managed with conservative treatments. Here are some of the most effective strategies:
1. Rest and Activity Modification
One of the first steps in treating rotator cuff tendinosis is to rest the shoulder and avoid activities that exacerbate the pain. This doesn’t mean complete inactivity, but rather modifying activities to reduce stress on the tendon. Avoid repetitive overhead motions and heavy lifting until symptoms improve.
2. Physical Therapy
Physical therapy is one of the most effective treatments for rotator cuff tendinosis. Our physical therapists in Upper Manhattan can design a customized exercise program to:
- Improve Strength and Flexibility: Strengthening the rotator cuff and surrounding shoulder muscles can help support the joint and reduce stress on the tendons. Stretching exercises improve shoulder mobility and prevent stiffness.
- Correct Posture and Mechanics: A therapist can provide guidance on proper posture and movement patterns to reduce strain on the shoulder during daily activities.
- Manual Therapy: Techniques such as soft tissue mobilization and joint mobilization can help improve blood flow, reduce pain, and promote tendon healing.
3. Medications
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce pain and inflammation. However, since tendinosis involves degeneration rather than inflammation, these medications should be used for pain relief rather than as a primary treatment.
4. Corticosteroid Injections
In some cases, corticosteroid injections may be recommended to provide temporary pain relief. However, these should be used cautiously as they do not address the underlying tendon degeneration and may weaken the tendon further with repeated use.
5. Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses high-energy shockwaves to stimulate tendon healing and reduce pain. It has shown promising results in some studies for tendinosis.
6. Platelet-Rich Plasma (PRP) Therapy
PRP therapy involves injecting a concentration of the patient’s own platelets into the affected tendon to promote healing. While more research is needed, PRP is a promising option for those with chronic tendinosis that hasn’t responded to other treatments.
7. Surgical Intervention
Surgery is usually considered a last resort for rotator cuff tendinosis, typically when there is a complete tendon tear or when conservative treatments have failed to provide relief after several months. Surgical options may include tendon repair or debridement.
Preventing Rotator Cuff Tendinosis
Preventing rotator cuff tendinosis is all about maintaining shoulder health and avoiding repetitive strain. Here are some tips that we typically share with our patients:
- Strengthen Your Shoulder Muscles: Regular strengthening exercises for the rotator cuff and shoulder muscles can help maintain tendon health.
- Maintain Good Posture: Practice good posture, especially during activities that involve prolonged sitting or standing.
- Warm Up Properly: Before engaging in sports or activities that involve the shoulder, perform a proper warm-up to prepare the muscles and tendons.
- Avoid Overuse: If you engage in repetitive shoulder activities, take frequent breaks to rest the muscles and tendons.
Schedule an Evaluation for Rotator Cuff Tendinosis
Rotator cuff tendinosis can be a painful and frustrating condition, but with the right treatment approach, it is possible to manage symptoms and regain shoulder function.
Park North Physical Therapy’s team of experienced physical therapists in Harlem and Morningside Heights can help you develop a personalized treatment plan to address your specific needs and get you back to doing the activities you love. If you’re struggling with shoulder pain, don’t wait—schedule an appointment with us today to start your journey to recovery.
For more information on our services, visit our website or call us at (212) 222-6525. Let’s work together to help you reach your potential!
