An irritation or inflammation of a tendon in the rotator cuff is called rotator cuff tendonitis or tendinitis. The rotator cuff, surrounding the shoulder joint, is comprised of muscles and tendons, connecting the humerus (upper arm) to the scapula (shoulder blade). The muscles allow the shoulder to rotate, and the tendons stabilize it. When the tendons are injured, it may cause a dull pain in the shoulder, which often gets worse when trying to sleep on the affected side.

What Is Rotator Cuff Tendonitis?

This is the inflammation of the bursa (a lubrication mechanism) and a group of muscles in the shoulder. If too much stress is put on the shoulder, it might cause tears and swelling in the tendons of the rotator cuff.

• Once inflammation begins, you typically have a dull ache radiating from a few inches below the top of the shoulder to the outer arm. Besides, simple movements can become painful, and overhead motions or reaching behind the body tends to increase the pain. It could interfere with sleep and even wake people up from a sound sleep with an aching pain in the upper arm. A clicking in the shoulder might occur when the arm is raised above the head. Besides, stiffness or a loss of mobility and strength in the affected arm may also happen.
• Rotator cuff tendinitis symptoms tend to worsen over a period of time. Initially symptoms can be relieved with rest. However, over time the pain could get worse or you may develop constant pain, because you actually have one or more small tendon tears. What's more, any symptoms that go past the elbow may indicate a more severe problem.

What Causes Rotator Cuff Tendonitis?

Rotator cuff tendinitis may be caused by:

•   Any occupation or activity that has you keeping the arm in the same position for long periods of time
• Favoring one arm to sleep on each night
•   Activities or sports that require the arm to be moved above the head repeatedly, such as throwing a ball, swimming, weight lifting and tennis
•   Any occupation that has the arm held above the head for many hours, and days at a time, such as carpentry or painting
•   A lack of coordination in terms of using the shoulder and shoulder blade muscles
•   Fraying of the tendons that occurs with age, and poor posture over many years

How to Diagnose Rotator Cuff Tendonitis

When you think your suffering is due to rotator cuff tendinitis and go for a doctor, you will go through the following diagnosis procedures:

• The doctor usually first exams the shoulder to see where the pain comes from.
• The doctor may also test the shoulder’s range of motion by moving it in different directions.
• Further tests might include checking the strength of the shoulder by having you press against their hands.
• Your doctor will also use tests to rule out other conditions, such as arthritis or a pinched nerve, which have similar symptoms as rotator cuff tendinitis.
• If your doctor thinks that you’re suffering from rotator cuff tendinitis, imaging tests may be ordered to confirm the diagnosis. Your doctor may order an MRI or ultrasound to check for any tearing of the tendons, and to look for any inflammation in the rotator. An X-ray may be ordered to see if you have a bone spur.

How to Deal With Rotator Cuff Tendonitis

If you keep using your arm despite the increasing pain, you may cause further damage. Early treatment may prevent your symptoms from getting any worse.

1. Rest

In order for the tendons to heal, the shoulder has to be rested. People need to stop doing whatever it was that caused the tendinitis to develop, whether it was caused by their occupation or sporting activities. If totally stopping is not possible, complications can be prevented by significantly reducing the activity. A splint, brace, or bandage can be used to help reduce movement. If the problem is severe enough, a plaster might be required.

2. Heat and Cold

Using an ice pack or warm compress may help to alleviate the pain and swelling in the shoulder. However, do not apply ice directly to the skin, but use a proper ice pack device or wrap the ice in a towel.

3. Physical Therapy

Physical therapy includes strengthening and flexibility exercises for the entire shoulder, which is very important in restoring and maintaining normal shoulder function. The physical therapist may also try treatments to relieve inflammation and pain, including electrical stimulation, cold laser, ultrasound, and the like.

4. Steroid Injection

Although steroid injections do not heal and cure the inflammation, it can be extremely helpful in soothing the acute inflammation and painful sensation of a rotator cuff. This allows people to continue their exercises and physical therapy in a comfortable and effective manner. However, repeated injections could weaken the tendon, thereby increasing the risk of a rupture.

5. Surgery

Continued loss of function and pain are the main reasons for surgery. Your physician might recommend surgery if your pain, strength and flexibility are not improving with non-surgical methods. Surgery for recurrent rotator cuff tendonitis is sometimes needed to:

•   Remove a bone spur on the acromion
•   Remove fibrotic bursal tissue that has become chronically inflamed and thickened
•   Tidy up and inspect the tendons or sometimes to repair a tear in the tendons
• There is a large tear
•   Symptoms last more than 6-12 months
• You have significant loss of functionality and weakness in the shoulder
•   You have an acute injury

Surgery for rotator cuff tendonitis will often involve re-attachment of the teared tendon to the upper arm bone. There are several options for repairing the tears, and your surgeon will discuss the best procedure to best meet your needs. Small open incisions or arthroscopic incisions might be considered whichever offers the better result. Possible risks may include bleeding, infection, wound healing, and nerve injury. Although rare, the shoulder may become very stiff.