About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

79 comments on “Rotator Cuff Tendinosis: Is a Cure Possible [Updated]

  • Parti tears of tge rotator cuff may be degenerative but I don’t agree tendonosis is correlated to degeneration. This would not change the underlying reasons why tendonopathy occurs such as poor scapula humeral rhythm, weak rotator cuff, posture, etc.

    Unfortunately I feel “a patch” is just medicalisation of a complex issue.

    • Tendinopathy in general implies internal degeneration — initially at a microscopic level. Then over time that can lead to fraying, “tearing” or dissolution of the attachment to the enthesis or bone.

      You are correct.. many people with shoulder pain have poor scapula-humeral rhythm and other disturbances such as an internal rotation contracture.. but these are different subsets of patients. Patients with poor scapula mechanics and control should not have their rotator cuff addressed surgically. It is incumbent upon the treating team to determine what the primary source of the pain is and direct a treatment plan accordingly.
      Thank you for your comment

  • I have just been diagnosed with shoukder tendinosis and have been told i am to have a steriod injection then physio. I am trying to find out more about the actual injection proeedure as i like to know whats im in for so to speak. how deep is the needle placed into the shoulder, will it be from the front side or back how long will it take to kick in and is there any viseos of this procedure being done that i could watch. many thanks yours hopefully cn

    • Have the injections and don’t worry. I am the biggest baby when it comes to needles. I have had 4 injections now in both shoulders and barely feel the needle at all. A few times I didn’t feel it go in and the other few times just a sting for a second. I am due for 2 more in a month and can’t wait as I can’t stand this constant pain;l

  • What is the schedule for restriction of activities following the procedure? I’m an athlete and personal trainer so I need to be functional with minimal down time.

    • Average is two weeks in a sling and progression from there. ROM restored usually within 4-6 weeks, return to lifting 4-6 months depending on the status of your tear and the quality of your tissue.

    • Hi, I had a motorbike accident 18 years ago and broke my glenoid clavicle and dislocated my shoulder. All healed well but about 5 years ago my shoulder was really sore and unable to raise it went down the physio route and all was well. Couple of days ago I was using my arm in a repetitive way and pressing down and my arm is really sore now and I can’t lift it in front of myself unaided. Painkillers aren’t helping and sleep is poor. Could this be rotator cuff tendinosis. Do I need to seek help or will it ease off?

      • After a severe injury it’s hard to say. You should consider a good exam and perhaps an Xray if your pain is severe. Night pain can be brutal. I would have someone check this out.

  • Hi Dr Luks,

    Do you know if the Rotator Medical Rotator Cuff Repair System has made it to the UK yet. Sounds really exciting rather than the operation and excessively long rehab I’m looking at.
    Kind regards,

    Geoff

  • Thanks Dr Luks, that’s a real pity, I suppose as with most things it might make it across the pond a little later!! Is it widely used Stateside yet?
    Kind regards,

    Geoff

  • Hello,
    Can I ask you: What is your opinion regarding the efficacy of stem cell treatments for rotator cuff tendinosis?

    Regards,
    Nelson

    • It is an emerging area of study. Many studies show very few changes, some studies show that it might help. Too early to say anything definitive… although some docs sure are pushing people hard to pursue this regardless of what the research shows.

  • Thanks for your reply. Being that I’m only a few hours away (PA), I think I will make an appointment with your office. In the meantime, I have one other question if you don’t mind:
    Is it possible that a steroid injection might help if oral anti-inflammatory drugs don’t?

    • Hi Nelson .. I can’t recommend treatments or medications via my website. We would be more than happy to see you in the office.
      914-789-2735

      Ask for Jenn

  • I believe both my arms are affected. I have discomfort at night, and my shoulders will go to “sleep”, depending on which side I sleep on. I may have to switch to sleeping on back, because it greatly reduces the issue. I think my inactive lifestyle and years behind a keyboard with forearms being supported by a desk all the time has resulted in atrophy and lack of good circulation. In order to “fix” this, I am losing weight, eating healthy, with emphasis on quality foods that reduce inflamation, and have started walking an hour a day to improve circulation. I do light arm/shoulder stretching and movements. I still have 90% of shoulder range of motion, but after a year, if the pain doesn’t improve, or the range of motion and pain worsens, I will look at the surgical option. I found the information you provided very informitive.

  • Dr. Luks I hope you don’t mind one more question (regarding the patch): Is the patch only used in cases where there is a tear, e.g., as per an MRI, or can it also be used in a case of chronic tendinosis to heal (i.e., “regenerate”) a tendon, but where there apparently is no actual tear? Thank you.

  • Dear Dr. Luks,
    I live in Dallas, TX and have a 8-10 mm partial tear with long standing chronic tendinosis with increased pain in the joint and upper biceps tendon. Do you have a recommendation for a local colleague to evaluate the possibility of using this patch?

  • Dear Dr. Luks

    Had rotator cuff surgery 10 years ago. Last few days something is “catching” about 2 on my collar bone when I raise my arm. Which than results in bad shoulder pain. Does this sound like rotator cuff again?

    Thanks Dan
    (South Jersey painting contractor)

  • Dear Dr. Luks

    One more question if I may. What is your opinion on the antibiotic cipro and whether it can cause tendon damage. I was on day 15 of cipro when my shoulder suddenly started hurting for no apparent reason.

  • Dr Luis;

    I had fraying and tearing in my left rotator cuff with severe pain and loss of motion. I had an anchor surgically placed in my left shoulder in Nov 2015. I still cannot lift my arm over my head or behind my back. I am in pain every day of my life. I went thru 6 months of physical therapy and nothing seems to be helping.

    Any suggestions ???

  • hi i am a nine year old and my arm pops but dose not hurt but when i throw a baseball or football hard it pops out and HURTS i was wondering if there is an sympnioton or what might be happening right now

    • Popping in the shoulder of a nine year old can be very normal with overhead sports.
      If it concerns your parents (parents always worry :-)) then they can take you to see a shoulder doctor.

  • what type of patch is this? who makes it? It sounds like this is not augmentation but a primary repair method, is that correct? I showed this article to my doctor, he wanted to know who made it but insisted a patch would be augmentation to the repair of my partial tear. i had surgery for a medial tear on dec 4th with 1 anchor and was fine till after 12 wks of therapy I went back to work, now im in excruciating pain esp. at night and have a tear in the same area. i now sleep in a recliner. Do you have anything I can tell him about this repair method? Thankyou

  • Dr. Luks: I am 71 and an MRI at HSS showed tendinosis and minor tears of the Rotator Cuff, and I am doing PT, but the pain seems to get worse from that. Is your patch FDA approved, and generally accepted
    in the orthopedic community? Can one resume all sports after this fix? thanks

  • thankyou for the response who makes this patch but what type of patch is it? that will tell me what its made from, thankyou

  • Hello , I’m an 83 1/2 year old guy ,health is very good except for my right shoulder. Back in January 2016 I was told that I had tendonitis the doctor gave me a shot of cortisone ,that took away he discomfort for about 4 months. I had to change doctors due to distance and the new doctor wanted to do a complete replacement but I didn’t go that route so I found a third Doctor that told me surgery was not needed at this time and
    I got another shot on May 11,2016 , okay now it’s August 23, 2016 and tomorrow I go to see this doctor again due discomfort ( not pain ). Any thoughts but here? Hear’s a kicker. I’m an avid shotgun shooter and was the Missouri shooter of the year also the national male athlete for shooting for 2014. So I have shot thousands of shotgun shells. Maybe your saying time for this old guy to get in the rocker??

    • Never… stay active… but perhaps shoot less. unless the pain is crippling you’re not having a shoulder replacement.

  • Dr. Luks, your website is very informative. My husband has been waiting for surgery and insurance is dragging their feet. It has been two months (10 weeks) since the injury. MRI shows multiple areas of tears and some arthrosis/hypertrophy and some bursal leakage. His pain is often extreme. He uses ice a lot. Perhaps this long waiting period is to better equip us to make the best choice possible. Your willingness to educate is very refreshing. Thank you.

  • i was just told through an MRI that i have a labrum tear and all he wants to do is surgery. said nothing of shots i have had pt. I think it has helped but still some pain. Because he is so ready to jump on the surgery bandwagon should i get a second opinion.im 48. thanks

  • Hi Dr Luks,

    I was recently diagnose with Shoulder Impingement, and Tendinosis; after an MRI. My surgeon says that surgery is not possible, and advised that I do physical therapy, he also says, I need to start surfing completely.
    I am considering paying out of pocket to do PRP treatment. Any advice?
    Is surgery not possible at this point to fix this issue?

    Thank you!

    Victor Rodriguez

    • Most patients will respond well to PT … Some like Dr Kirsch’s approach with hanging from a bar.
      Hold off on PRP until you know whether or not PT makes a difference.

  • Dr. Luks, Thanks for the informative article. May I ask your opinion on the effectiveness of ARPwave therapy to treat tendonosis of the supraspinatus? Does it cure tendonosis?

    • It’s very tough to cure tendinosis… biology is difficult to alter. I’m not aware of any scientific proof that ARP cures tendinosis.

  • Hello Dr. Luks,
    I have had on and off shoulder pain in both shoulders and even saw an orthopedist about this pain and was told it was my AC joint. It would last a few weeks and get better. I do enjoy lifting weights and excercises like military press, Arnold Press with dumb bells and front, side and back raises of the arms. My pain is much different now and only in one shoulder, my left. Sleeping is bothersome and I fold the blankets under that arm to help with the pain. It is sounding like there might be a rotator issue now. I live in Germantown MD. Can you recommend any Dr.’s downthis way? I am originally from Rye, NY so Hawthorn is close to there, but now not so much. Any information would be appreciated.
    Best Regards.
    Bill

  • Richard Anderson ;

    Greetings; Doctor I have a full thickness tear of the anterior supraspinatus tendon with under surface

    partial tear of the remainder of the tendon. I also have Moderate biceps tendinosis with tenosynovitis.

    Question; Would the patch help in either case ?

    Thank you for your assistance. Regards; R. Anderson.

  • Hello, very informative article and led me to want to research further! I like many others have been diagnosed through MRI & orthopedist with bone spur/some degeneration and have the most horrible time sleeping. I am a 43 yr old male and just want my life back. Unfortunately I feel as if my other shoulder is now having instability/popping/pain. Cannot stand the numbness at night and now have developed tinnitus for about a month. I’ve seen a couple different docs & PT. Any recommendations way out west, Denver area?

  • Hi Dr Luke’s,

    Thanks so much for your article! I have left RTC tendonosis, Labrum fraying, AC joint degeneration & I am only 39. I have most of the symptoms listed in your article (can’t sleep at night, can’t reach back or up without pain). I have had 2 steroid injections without improvement. I’m waiting on PT to begin but should I be seen by ortho? If so do you have recommendations for anyone south of the Chicago area?

    Thanks!

  • Is this treatment available in Canada? I’ve been dealing with chronic rotator cuff tendinosis pain for 2 years, Have done 3 rounds of 6-8 weeks of physio/exercises, massage, chiro, anti-inflammatories, muscle relaxers, gels/rubs, prescription medications, accupuncture, heat therapy, cortisone and lidocaine injections and shockwave therapy. Really looking for some long term relief!

    • I do not know if this is available in Canada. The company who manufacturers it is called Rotation Medical. Perhaps you can call them. The injection you mentioned in another post might help.
      Good Luck

  • I just stopped doing crossfit after 5 months because of these exact symptoms. My question is if this is not degenerative, will it repair itself?

    • I’m not sure Dennis… you can reach out to Rotation Medical. They will let you know.
      We are in Mid-Westchester on the 287 corridor if you need us.

  • Thank you Dr Luks, this article was very helpful for our family. It has given us a very clear picture of tendinosis as well as options for moving forward with recovery. My 14 year-old son was just diagnosed through MRI today with supraspinatus tendinosis and bursitis. He has been a competitive swimmer for 6 years and a triathlete for 2 years. He is unable to elevate his arm beyond 90 degrees from his body. His arm remains in a sling to manage pain. Pain killers have done little to give him any relief. He has been attending physiotherapy, chiropractic and massage appointments weekly for the past 8 weeks with little to no improvement. We live in Canada so we are hoping to find an Orthopaedic Surgeon that will take a look at him here now that we have an MRI. Have you had any success with your patch surgery in younger patients?

    Thank you in advance for your time.

    • Hi Trina…
      We have had success in very young patients… but most of them recover with PT and do not need surgery.

  • Doctor, will a previously fractured and separated, but not repaired, A-C joint (old MVA injury) exacerbate the repair of a “Full-thickness, leading-edge tear of the left supraspinatus tendon, superior labral tear with biceps subluxation?” In other words, does a pin need to be inserted in the A-C joint fracture BEFORE the tendon is repaired?

    • Not necessarily… if you have lived with the AC Joint issue for a while and it doesn’t cause you problems then it shouldn’t need to be stabilized now. But with complex cases like this, the examination and your complaints are what matters most in decision making. So I can not tell anyone whether or not any of the procedures you mentioned are necessary without examining them and talking with them.

  • Hi. I am 32 and after 6 years of pain getting increasingly worse, physical therapy I feel has made the pain worse and the injections of cortisone only a temporary fix, I was just told I have acute tendinosis in at least 2 of the tendons in my shoulder. I’m at the point where I have sports tape on all the time, Bengay and tiger balm are my best friends and I’m maxing out on motion almost everyday. I’m an emt so lifting is a big part of my job. Some days, I need help getting dressed, today I couldn’t even brush my hair. The pain shoots all the way down my arm, sometimes into my hand and shoots up my neck to my jaw. Is this patch something that only you do or is there a Dr. closer to southern California that I can consult with? I am in desperate need of advice. My mobility is at about 10-15% and getting worse everyday.

    • The patch is Distributed by Rotation Medical. Perhaps they can help you find someone close to you who can evaluate you.

  • I’ve suffered for the last 16 months after a car accident. I’ve seen 2 different orthopedic surgeons and completed 12 weeks of physical therapy. My rotator cuff is intact but I have multiple strained tendons, bursitis, and mild ac joint arthropathy. I have a high tolerance for pain, I’ve had natural childbirth 5 times. Every time I think I’m better something happens to set me back. I was good for a while until I slept on it last night and now I’m in terrible pain. Can you recommend a Dr. near Colorado Springs, CO? I’m at my wits end. Do you think this patch would help me or what should I do? Thank you!

    • Sadly.. without examining you I can not tell you if the patch would be useful. The company who makes the patch is Rotation Medical. They can tell you if there is a surgeon near you.

  • I really learned a lot in this article. I am 62 and started having rt shoulder pain. Had a cortisone injection which did nothing. The pain and ROM worsened. I had an MRI with Moderate rotator cuff tendinitis with undersurface fraying and partial tear in of the distal supraspinatus tendon. A linear signal alteration in the intra articulated long head of bicep tendon, glenohumeral joint effusion with Synovitis. AC joint hypertrophy and a prominent inferiors directed osteopath. Yikes. Very painful with movement. Are there other options other than surgery? Might the patch be appropriate in this situation? Thank you

    • Only after a thorough evaluation and exam could I tell you if I thought the patch would be useful.
      Sorry… hope you feel better.

  • Great great article! Would like to know if I should continue my daily upper body strength exercises (I’m 88 years old) as I deal with the shoulder/arm pain? Thank you for your response.

  • I’m now 59 yo, male, very active and in good shape. I’m scheduled for surgery to fix rt supra cuff that was repaired 20 yrs ago (traditional open fix for large tear due to fall on wet floor) and has been trouble-free up to this latest tear. Can tendonosis be seen on MRI/arthrogam & ultrasound scans? I mentioned that maybe tendonosis was setting in that caused this latest tear, but Dr. did not mention that when he read my MRI. Or, will he only be able to see it when he goes in and then discovers my tendon repair will require a patch due to bad tendon integrity? tx.

    • HI…
      Many rotator cuff repairs will degenerate over time and lead to another tear. These recurrent tears are not uncommon. Many are due to tendinosis once we reach middle age. The MRI should reveal changes consistent with rotator cuff tendinosis.

      At the time of arthroscopy we are also able to tell by simply looking at the quality of the tendon. In most institutions the patch needs to be ordered in ahead of time. There are different patches available for different situations. The results of revision rotator cuff repairs is not as good as the results of the repair of the initial tear. Therefore many of us prefer to have some form of patch augment available just in case.

  • 11 days ago I hurt myself in a very weird way when I was reaching for something at shoulder height and I suddenly snapped arm back because I was startled to see a spider. Now right arm is very limited in range of motion. Can barely move arm up only somewhat close to my body. Hurts especially in front part of the deltoid. I’m trying to avoid surgery but looks like healing time will be much longer than I thought originally. If at all possible. At first, I had more expectation of better outcome because I’ve usually been a good healer but not sure now . I’ve gotten a lil better but will see doctor on another matter and tell her about it.

    • Shoulder strains, and in particular strains of the rotator cuff can take weeks to months to improve. Shoulder surgery can be an even more lengthy recovery.

  • Thank you so much for your articles on rotator cuff surgery. You’ve explained in plain English everything necessary for a patient to know and understand. I feel validated for choosing surgery after two years of waking up from intense shoulder pain. I’ve done two rounds of physical therapy, one Cortisone injection, and countless acupuncture, massages, meditation, And even journaling. I was lucky to find a doctor who has experience with biological patches. One of the doctors I consulted simply wanted to remove the bursa. I was wondering what your view is of biceps tendoniesis surgery as an adjunct to rotator cuff surgery. Thanks!!

    • HI Liz… The biceps can be a troublemaker in many shoulders. I do not routinely tenodese the biceps in all shoulders, but if I think that it has a role in your pain, or if your imaging shows degeneration, a split tear or narrowing around the biceps then I will usually perform a tenodesis. If I find the biceps is unstable due to ligament injuries around the “rotator interval” at the time of arthroscopy, I will also tenodese the biceps.

  • Dr Luks, I have severe pain in my R shoulder at rest, and with certain movements. I have been diagnosed with the following after MRI: 1. severe tendinopathy of distal of supraspinatus and infraspinatus tendon with focal high-grade, partial thickness tear of of bursal surface of ant supraspinatus tendon extending to greater tuberosity, but not clearly extending to articular surface; 2. severe tendinopathy and chronic appearing mod grade partial-thickness tear of articular surface of distal suprascapularis tendon; 3.Mild lateral downslope of acromion and small subacromial enthesophyte causing mild narrowing of supraspinatus outlet – likely cause for rotator cuff impingement; 4. severe acromioclavicular joint osteoarthritis.

    Couple of questions if I may. Do you believe the Rotator Cuff Patch would be beneficial in my case? Is it accepted by most insurance companies? Which company manufactures the Patch? Thank you

    • That is a very common age-appropriate MRI interpretation. Despite those findings, it doesn’t mean that those changes are the cause of your pain. Many, many people have similar changes and no pain. Figuring out what the cause of your pain is can be challenging… but if successful can determine what your “best” options are. There’s no doubt and no debate that physio or PT is the first line of treatment for everyone with these changes when your doc thinks that the pain is caused by your rotator cuff. If and only if non-surgical treatment is ineffective do we consider moving to surgery as an option. The patch may or may not be a worthwhile consideration in the future. It is made by Smith and Nephews.

  • Hi Dr. I am having tightness but not pain and movement of shoulder is also good in my right shoulder for about 2 months.I also hear sound and feel something is clicking inside when i move my shoulder. I visited doctor and done x ray and ultrasound. ultrasound says” the supraspinatous tendon is bulky and heterogeneously hypoechoic, suggestive of tendinosis. Focal hetero-echogenicity is also seen in subscapularis tendon, suggestive of tendinosis.” The doc told to do Physiotherapy and i am doing that from 1 month but the improvement is not as such. As i told you there is no pain but i feel the muscle tightness around the shoulder and it irritates me a lot. So doc please suggest me that should i continue physiotherapy or there is surgery or steroid injection required for that. Before this happened i was going gym regularly. How much time physiotherapy take generally to heal this type of injury. Please doc help i am getting depressed because of this.

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