Approximately 30% to 50% of adults will experience at least one episode of shoulder pain during their lifetime, and rotator cuff tendinopathy is one of the most common causes—accounting for between 44% and 65% of all shoulder pain.

You will discover what this injury really is, why it occurs, and, most importantly, how to speed up your recovery.

What is rotator cuff tendinopathy?

Rotator cuff tendinopathy is irritation or degeneration of the tendons that stabilize your shoulder. The rotator cuff consists of the tendons of four deep muscles that keep the head of the humerus (the arm bone) centered in the shoulder joint.

This injury affects approximately 1 in 5 people during their lifetime, particularly after the age of 50. It generally develops gradually, unlike a traumatic tear that occurs during an accident.

Now that you understand what this injury is, let's look at why we sometimes refer to it as "tendinitis" and sometimes as "tendinopathy."

What is the difference between tendinitis and tendinopathy?

Both terms essentially describe the same condition: pain in the shoulder tendon.

Tendinitis refers to inflammation of the tendon. Tendinopathy refers to tendon damage that may or may not be accompanied by inflammation. Modern research has discovered that many cases of tendon pain do not involve active inflammation, but rather a disruption of the tendon fibers. This is why the term "tendinopathy" is now preferred.

In both cases, the treatment is identical. Physical therapists use the same approaches for both conditions.

Now that you know how to tell them apart, let's explore the four muscles that make up the rotator cuff.

What are the four muscles of the rotator cuff?

The rotator cuff consists of four deep muscles that work together to stabilize your shoulder:

The most frequently injured muscle. It allows the arm to be raised to the side in the early stages of movement. Its tendon passes through a narrow space under the acromion, making it vulnerable to friction.

It allows external rotation of the arm—the movement used to open a door or throw a ball. Crucial for posterior shoulder stability.

Small but powerful, it works with the infraspinatus for external rotation.

The only muscle of the rotator cuff located on the front side. It allows internal rotation—the movement to place your hand behind your back. Essential for keeping the head of the humerus centered.

These four muscles must work together perfectly. When one of them is weakened or irritated, the entire system can be affected.

If you recognize that you have difficulty with these movements, you are probably wondering what other symptoms could indicate tendinopathy.

What are the symptoms of rotator cuff tendinopathy?

The most common symptoms are:

The pain develops gradually, over several days or weeks. It is often located on the side or front of the shoulder and may radiate down the side of the arm to the elbow (but rarely beyond).

You feel the pain particularly when you:

• Raise your arm to the side or forward
• Reach for items on a high shelf
• Put on your coat
• Place your hand behind your back.

Difficulty lifting even light loads. This weakness may be caused by pain (muscle inhibition) or by a loss of strength if the tendon is damaged.

Increased pain at night, especially when lying on the affected shoulder.

Your shoulder may feel stiff when you wake up, requiring a few minutes to "warm up."

Sharp pain in a specific portion of your arm's range of motion (usually between 60 and 120 degrees of elevation).

If you recognize several of these symptoms, you are probably wondering why this is happening to you.

What REALLY causes rotator cuff tendinopathy?

We often hear that tendinopathies are caused by age-related "degeneration"—as if your tendons were doomed to deteriorate.

Tendinopathies occur when there is an imbalance between the load placed on the tendons and their ability to tolerate that load. Think of your tendons as muscles: they adapt to the demands placed on them.

Here are the real causes:

Your tendons haven't had time to adapt. Examples:

• Painting the ceilings in your house over a weekend
• Starting a tennis or volleyball season without gradual progression
• A week of canoe camping without being used to these movements
• Moving and carrying boxes above your head

Workers who perform hand movements above shoulder height for more than 2 hours per day are 2.4 times more at risk.

If you have been less active, your tendons lose their tolerance to exertion. Returning too quickly can exceed their capacity.

• Over 50 years of age (3.3 times higher risk)
• Diabetes (2.2 times higher risk)
• Poor coordination of the shoulder muscles
• Weakness of the shoulder blade stabilizers

Now that you understand the real causes, let's see how to confirm this diagnosis.

How is rotator cuff tendinopathy diagnosed?

The diagnosis is mainly made through clinical examination—your physical therapist usually does not need medical imaging.

Your physical therapist will ask you detailed questions about when the pain started, the movements that cause it, and your recent activities.

Provocation tests that stress the rotator cuff tendons:

• Strength tests for each muscle
• Compression tests (Neer, Hawkins-Kennedy)
• Range of motion assessment
• Palpation of structures

X-rays do not show tendons. Ultrasound or MRI can visualize tendons, but these tests are not usually necessary to begin treatment. Your physical therapist may recommend imaging if:

• Your symptoms do not improve after 6 to 12 weeks
• They suspect a complete tear.
• Surgery is being considered.

You do not need to see a doctor before consulting a physical therapist in Quebec.

Once the diagnosis has been confirmed, let's look at the most effective treatments.

What physiotherapy treatments are available for rotator cuff tendinopathy?

Physical therapy is the treatment of choice with a high success rate.

Your physical therapist will identify the contributing factors:

• Joint mobility
• Strength and stability
• Quality of movements
• Nerve slippage

• Joint mobilizations to improve movement
• Soft tissue therapy
• Techniques for realigning the humerus

• Isometric exercises without movement
• Active movements within comfortable ranges

• Progressive range exercises
• Light strengthening of the rotator cuff muscles
• Activation of the shoulder blade stabilizers

• Progressive strengthening with resistance
• Functional exercises

How to balance your activities, which movements to modify, and how to progress gradually.

You're probably wondering how long all this will take.

How long does it take for rotator cuff tendinopathy to heal?

• 7 to 10 days: Significant reduction in pain
• 2 to 4 weeks: Return to light activities

• 6 to 12 weeks: Gradual improvement with physical therapy
• 3 to 6 months: Full return to activities
• 50% of patients improve within 6 months, 60% within 12 months

• 3 to 6 months: Intensive rehabilitation program
• 6 to 12 months: Complex cases or cases involving partial tears

• Early consultation
• Adherence to the exercise program
• Appropriate modification of activities

• Continue painful movements
• Complete rest
• Uncontrolled diabetes
• Smoking

While waiting for your appointment, let's see what you can do right now.

What can you do at home to relieve rotator cuff tendinopathy?

Adapt, don't eliminate. For example: place heavy boxes at mid-height rather than above your head, do short sessions with breaks.

• Cold: 15 minutes, 3-4 times/day during the acute phase for analgesic effect
• Heat: 15-20 minutes, 1-2 times/day for chronic tendinopathies

• Avoid sleeping on the painful shoulder.
• Do not place your arm behind your head.
• Support your arm with a pillow.
• Ensure proper cervical support

• Pendulum: Lean forward and gently swing your arm in circles.
• Assisted lifting: Use your healthy arm to help the painful arm.
• Sliding on the wall: Slide your hand upward.

Keep your shoulders slightly back and down.

NSAIDs may provide short-term relief but could hinder long-term tendon healing.

• Persistent pain after 7–10 days
• Pain that worsens
• Marked weakness
• Pain that wakes me up every night

Rotator cuff tendinopathy is not a life sentence. It is an injury that responds well to treatment when you understand what is happening and follow the right steps.

• Your tendons are not "worn out"—they are reacting to an overload they were not prepared to bear.
• 50 to 60% of people improve naturally within 6-12 months.
• Physical therapy speeds up recovery and reduces the risk of relapse.
• Progressive movement is your best ally

If you experience persistent pain, don't let the situation become chronic. The sooner you seek medical attention, the faster you will recover.

To learn more, check out our comprehensive guide to shoulder pain or discover how physical therapy can help your shoulder.

If you are concerned about a more severe tear, read our article on rotator cuff tears.