What It Is, Why It Hurts, and How to Treat It
Shoulder pain is one of the most common musculoskeletal complaints among adults — affecting athletes, manual labourers, office workers, and older individuals alike. Among the leading causes is rotator cuff tendinitis, an inflammation of the tendons that stabilise and move your shoulder.
This condition can make even simple tasks — reaching up, dressing, lifting a kettle — unexpectedly painful. The good news is that rotator cuff tendinitis is highly treatable with the right care.
This guide breaks down the causes, symptoms, diagnosis, and treatment options available in South Africa.
What Is Rotator Cuff Tendinitis?
The rotator cuff consists of four key muscles and their tendons, working together to stabilise the shoulder joint and allow overhead movement.
Rotator cuff tendinitis occurs when one or more of these tendons becomes inflamed or irritated. This inflammation leads to pain, reduced range of motion, and weakness — often worsening with activity or at night.
The condition typically results from overuse, age-related changes, posture issues, or injury. If ignored, it can progress into partial tears, chronic pain, or shoulder impingement.
What Causes Rotator Cuff Tendinitis?
Rotator cuff tendinitis develops when the tendon experiences more load than it can tolerate. Common causes include:
Repetitive Overhead Movements
Activities that involve frequent overhead arm use can overload the shoulder tendons, such as:
- Painting and manual labour
- Swimming
- Tennis
- Gym workouts with overhead lifting
Age-Related Degeneration
From the age of 40 onward, tendons naturally become less elastic and more prone to irritation and small micro-tears.
Poor Posture
Forward-rounded shoulders or long hours spent hunched at a desk narrow the space in which the rotator cuff moves, creating friction and inflammation.
Sudden Strains or Injuries
A fall, rapid lift, or twisting movement can irritate or inflame the tendon.
Shoulder Impingement
Swelling in the structures above the tendon can compress it, worsening inflammation.
Rotator cuff tendinitis is especially common in:
- Athletes
- Construction workers
- Teachers and hairdressers
- Office workers
- Adults over 50
Recognising the Symptoms
Rotator cuff tendinitis symptoms may develop gradually or after a specific overload event.
Typical symptoms include:
- Pain when lifting the arm, especially overhead
- Weakness when reaching or carrying items
- Clicking or grinding with shoulder movement
- Night pain, especially when lying on the affected side
- Pain radiating into the upper arm
- Stiffness and reduced mobility
Early vs Chronic Symptoms
Early tendinitis: pain with movement, mild inflammation
Chronic tendinitis: persistent pain, limited movement, risk of tendon degeneration or tears
Symptoms lasting longer than 2–3 weeks should be assessed by a clinician.
How Rotator Cuff Tendinitis Is Diagnosed
Diagnosis begins with a detailed clinical assessment.
History & Physical Examination
A pain specialist or physiotherapist will assess:
- Range of motion
- Strength
- Posture and biomechanics
- Pain patterns
Common orthopaedic tests include:
- Painful Arc Test
- Empty Can Test
- External Rotation Lag Test
Imaging
When needed:
- Ultrasound (excellent for detecting tendinitis and small tears)
- MRI (used for more complex or unclear cases)
X-rays cannot diagnose tendinitis but may reveal bone spurs or joint narrowing.
Treatment Options in South Africa
Treatment depends on severity, symptoms, and functional demands — but most patients improve without surgery.
Rest and Ice
Short-term rest and icing calm inflammation and ease acute pain.
Medications
- NSAIDs (e.g., ibuprofen or meloxicam) for inflammation
- Topical anti-inflammatory gels
- Short courses of pain medication if needed
Physiotherapy
The cornerstone of recovery.
Physio focuses on:
- Rotator cuff strengthening
- Scapular stabilisation
- Posture correction
- Stretching tight muscles
- Restoring pain-free mobility
Corticosteroid Injections
Used for severe symptoms or when inflammation is high. Provides rapid relief but should be used judiciously.
Interventional Pain Procedures
For chronic cases or severe inflammation, pain specialists may offer:
- Targeted nerve blocks
- Pulsed radiofrequency neuromodulation to modulate pain pathways
- Treatment for cervical spine-driven shoulder pain (if referred pain is suspected)
These procedures can significantly reduce pain and allow physiotherapy to progress.
Surgery
Reserved for:
- Major rotator cuff tears
- Severe impingement not responding to therapy
- Persistent pain despite comprehensive management
Procedures may include arthroscopic repair or decompression.
Exercises and Recovery Tips
Physiotherapy programmes typically include:
Pendulum Swings
Gentle movements to lubricate the joint.
Wall Crawls
Improves overhead range of motion.
Shoulder Blade Squeezes
Strengthens stabilising muscles.
External Rotation Strengthening
Supports rotator cuff fibres.
Posture Training
Correcting rounded shoulders reduces tendon friction.
Consistency is essential. Progress is gradual — usually over 6–12 weeks, depending on severity.
How to Prevent Recurrence
Once healed, rotator cuff tendinitis can return unless underlying factors are addressed.
Preventative strategies include:
- Maintaining good shoulder and scapular strength
- Avoiding repetitive overhead strain
- Warming up before workouts
- Using correct workplace ergonomics
- Keeping good posture
- Gradually increasing training loads
Athletes and manual labourers should consider periodic physiotherapy check-ins.
When to See a Specialist
Seek medical attention if you experience:
- Pain lasting longer than 2–3 weeks
- Night pain interfering with sleep
- Sudden weakness in the arm
- Inability to move the shoulder
- A suspected tear
- Pain following a fall
- Recurrent tendinitis
Specialists at pain clinics, orthopaedic centres, or physiotherapy practices can diagnose and treat shoulder tendinitis effectively.
Final Thoughts
Rotator cuff tendinitis is common — but highly treatable. With early diagnosis, targeted physiotherapy, and (when needed) interventional pain procedures, most people regain full function and return to normal activity without surgery.
If you’re living with ongoing shoulder pain, seeking proper assessment is the first step toward recovery. With the right care pathway, relief is not only possible — it’s likely.
FAQs
1. What are the early signs of rotator cuff tendinitis?
Pain when lifting the arm, mild weakness, and discomfort when lying on the affected shoulder are common early signs.
2. How long does it take for rotator cuff tendinitis to heal?
With consistent physiotherapy, most people recover in 6–12 weeks. Chronic cases may take longer.
3. Can rotator cuff tendinitis lead to a tear if untreated?
Yes. Ongoing inflammation weakens the tendon and increases the risk of partial or full tears.
4. What are the best exercises for rotator cuff recovery?
Pendulum exercises, wall crawls, rotator cuff strengthening, and posture work are essential.
5. When should I see a doctor for shoulder pain?
If pain lasts more than a few weeks, worsens, involves sudden weakness, or interferes with daily life.