Rotator Cuff Tendon Pain

Rotator cuff tendinopathy is wear-and-tear pain in the four tendons that wrap around the top of your shoulder and let you raise and rotate your arm. It most often affects the one that runs across the very top (the supraspinatus). The tendon gets thickened, disorganized, and painful when you load it. It sits on a spectrum: a tendon that is slowly breaking down can stay just sore for years, partially tear, or finally rupture all the way through. A common painful variant is calcific tendinopathy, where chalky calcium deposits form inside the tendon and trigger sudden, severe pain flares.

• Aching pain on the outside of your shoulder and upper arm, especially at night or when lying on the affected side.
• Pain when reaching overhead, putting dishes away, shampooing your hair, or reaching behind your back.
• A painful arc: lifting the arm out to the side hurts most between about chest height and ear height.
• Tenderness right over the bony bump on the outer shoulder (the greater tuberosity).
• Gradual onset: there is usually no single injury, just a slow buildup over weeks or months.
• Sudden, intense flare of pain (with the calcific variant) that may come on overnight and make any shoulder movement excruciating.
• Weakness with overhead lifting or rotating the arm outward.

The exam usually tells the story. Typical findings are pain on the outside of your shoulder and upper arm, especially when reaching overhead or lifting, and tenderness over the bony bump on the outer shoulder where the tendons attach. There is also a painful arc: lifting the arm out to the side hurts in the middle of the motion, typically from about chest height to ear height. X-rays may show chalky calcium deposits. Ultrasound or MRI shows the thickened, disorganized tendon and any partial tearing.

When a cuff tendon is just sore, not torn through, strengthening is the cornerstone of getting better. Care builds in order: each step below is added on top of the ones before it, not instead of them. We start with the exercises that retrain the tendon. Medication and a targeted injection are used only to quiet a flare so you can keep making progress. The procedural and surgical options are saved for the stubborn cases that have not settled with everything else.

1. Barbotage (needle lavage)

   For the calcific variant, an ultrasound-guided needle is used to break up the calcium deposit and flush it out (a procedure called barbotage). It is very effective for the calcific kind specifically.

2. PRP injection

   An injection of platelet-rich plasma (PRP) is made from your own blood and placed into the damaged tendon. It may be considered for partial tears that have not settled after rest, activity changes, physical therapy, NSAIDs, and a steroid injection. The evidence for it is limited and mixed. It is not covered by insurance (self-pay).

Surgery comes into play for two stubborn situations. The first is the calcific variant that will not quiet with needling and rehab. The second is partial-thickness tears that are getting worse on imaging despite six months or more of structured non-operative care. The procedure is done arthroscopically, through small puncture holes with a camera.

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language