Rotator cuff tendinosis is a very common cause of shoulder pain. Your rotator cuff tendons control the motion of your shoulder joint. They are four very important muscles and their structure can change with age, or because of your activities.
What is Rotator Cuff Tendinosis?
Tendinosis of the rotator cuff is a degenerative (genetic, age or activity related) change that occurs in our rotator cuff tendons over time. Rotator cuff tendinosis is exceptionally common. Although many people with shoulder pain will be found to suffer from tendinosis. Many, many people have tendinosis of the rotator cuff and do not even know it. Why rotator cuff tendinosis bothers some people and doesn’t bothers others is currently a question the orthopedic surgery community can not answer. Rotator cuff tendinosis is just as likely to be found in a professional body builder as it is likely to be found in a true couch potato.
What does Rotator Cuff Tendinosis Look Like?
In this photo, the white round structure on the right is the top of the humerus. The frayed tissue just to the left is the rotator cuff. This patient was suffering from rotator cuff tendinosis and a partial-thickness cuff tear.
Tendinosis represents a structural change in the tendon at a microscopic level. This results in disorientation of the tendon structure and, ultimately, partial tearing as the weakened tendon gives way. The analogy I always use is your favorite pair of blue jeans. You wear them for years and then one day you feel a breeze down by your knee — you look down and there’s a hole. No trauma, no accident… the fabric just wore out.
Therefore, rotator cuff tendinosis is not the result of a single traumatic event. It is brought on by genetics, age and repetitive activity. We are not sure why some patients with rotator cuff tendinosis have pain, and others do not.
How Do We Treat Rotator Cuff Tendinosis
Many patients with rotator cuff tendinosis and partial tears do not require surgery and will respond very well to a coordinated physical therapy program to strengthen the remaining cuff tissue. Moist heat, Ice and anti-inflammatories can work well, too.
Rotator cuff tendinosis is a biological problem … our body is actually changing the tendon tissue. Only very recently have treatment techniques evolved to enable us to treat rotator cuff tendinosis that fails to respond to non-surgical measures. It is a technology developed by Rotation Medical and enables us to place a “bioinductive” patch over the area of tendinosis, which over a period of a few months has been shown to reverse the degenerative changes and heal your tendon.
Over time, this patch will incorporate into the tendon and alter the structure of the tendon. Most patients .. in our series to date, have had significant relief, even after trying other surgical procedures first which had failed.
You can read more here about this approach to treating shoulders with rotator cuff tendinosis.
Jalen
The power of health care and social media… and a firm digital footprint.
“A wonderful job. Super helpful information.”
Howard J. Luks, MD
Thanks Jalen…
andrea
I have RSD AKA CRPS in my right foot and ankle and I go every 3 months for a lumbar block in order to keep it in check… when the shots wear off my foot starts to hurt and and freeze up … lately my shoulder was giving me problems so I had it looked at and after my MRI was told I had tendinosis… my question is this … is the reason I am having so much pain with my tendinosis because of the RSD? I dont have the swelling and the blotchy purple looking skin but the frozen range of motion and the pain and tingly feeling are there… maybe Im just paranoid because of the last RSD episode… (it was awful) and was brought on by Achilles tendon damage. Any input would be greatly appreciated as not many doctors are familiar with this disorder
Howard J. Luks, MD
Andrea … anyone with a history of CRPS is going to worry that any new discomfort is related… Completely understandable. While CRPS can occur in other areas, it is well known that tendinosis can cause fairly significant pain. Sometimes selective injections of the shoulder under ultrasound guidance can help determine what the source of the pain is.. and treat the pain as well. The hallmark of CRPS or RSD is pain out of proportion… the color changes and skin changes actually occur fairly late in the process. Your surgeon should be able to help you determine if this pain is related to the shoulder, the rotator cuff tendinosis or perhaps CRPS.
Good Luck1
HJL
Stephanie
What a great website! I’ve learned more here than I have from my doctors and research combined. I have severe pain at night and when I googled it, I found your website. I have full thickness tears in both shoulders and a bone lesion. I am a school teacher am waiting to schedule my surgery date. I’m not pleased with my doctors bedside manner and am waiting to see if my insurance will approve another …healthcare is Mississippi is not easy and I have good insurance. I am afraid that my tendon retraction and atrophy is to the point where surgery may not can help. I am going back to explore more on your website and educating myself more.
Howard J. Luks, MD
Very kind of you Stephanie … Good Luck !
Dorothea
Here’s my history: I’m 33 and active in many different kinds of sports (rowing, skiing, swimming, going to the gym). Four days ago I felt a sudden pain in my shoulder when holding on (with my arm straight, flexed foreward) to a big rowing boat (for 14 rowers) when it moved with greater force than I had expected. Since then I’ve had a dull ache in my shoulder (also at night, but it’s not very severe and I still can sleep most of the time). I have full range of motion and no additional pain when moving my shoulder in different positions (abduction, adduction, internal and external rotation). I haven’t noticed any pain when trying to palpate (maybe a little tenderness at the subacromial space, but I’m not sure. I’m not good at palpating). My question is: can this be a tear despite any pain with movement of the shoulder, only at rest. What else can it be? Should I see a doctor and if yes, how soon? I’m now taking NSAIDs and resting the shoulder. Is it safe to take pain (or the lack of it) as an indicator for when it is safe to return to normal activities, like rowing. I’m quite worried and really appreciate your web page (I’ve learned so much from reading it) and you answering people’s questions so kindly.
Howard J. Luks, MD
Hi Dorothea…
The major offenders in that case are the rotator cuff, the labrum and the biceps. Without examining you it’s obviously impossible to say which it is. If rest, stretching, and perhaps routine over the counter medications are not improving your symptoms then after a week or two I would probably see an Orthopedic Surgeon who specializes in treating the shoulder.
Howard Luks
Darlene
I’m now a 55yr old female that was working as an overnight grocery stocker. It required me to do a lot of lifting and arm movement when stocking the shelves. I had tennis elbow and wrist surgery. Over a period of time my shoulder started to cause me pain. In 2009 I was to have surgery on my shoulder(rt) due to circumstances I didn’t.,the pain sometimes goes to the left but mostly on the right. I left my job of 28yrs because the pain has gotten much worse and because workmans comp has denied me I have no medication and after what I was prescribed doesn’t help the pain. Why is it that not doing anything still cause pain and is there any resource. I was told that the headaches is caused by it also, thank you for your help
Howard J. Luks, MD
Rotator cuff pain is frequently very severe at night. The night pain component can keep us awake, interfere with our ability to get a full nights sleep —> which leads to stress. We’re not sure why the rotator cuff hurts so much even at rest or at night, but it is a very common complaint among patients.