Initial Treatment for Rotator Cuff Tendinitis
The initial treatment for rotator cuff tendinitis should include exercise therapy focusing on rotator cuff strengthening and scapular stabilization, along with NSAIDs for pain control. 1
Conservative Management Approach
First-Line Interventions
- Exercise therapy has demonstrated beneficial effects in decreasing pain and improving function in patients with rotator cuff-related symptoms 1
- NSAIDs are recommended as first-line pharmacological treatment to reduce pain and inflammation 1
- Activity modification to avoid aggravating movements should be implemented during the initial treatment phase 1
- Both supervised and home-based physical therapy programs can lead to improvements in outcomes 1
Exercise Program Components
- Focus on rotator cuff strengthening exercises 1
- Include scapular stabilization exercises 1
- Incorporate range of motion exercises as an important component of rehabilitation 1
Medication Options
- NSAIDs help reduce pain and inflammation associated with rotator cuff tendinitis 1, 2
- A single injection of corticosteroid with local anesthetic may be considered if initial treatments are inadequate, providing short-term improvement in both pain and function 3, 1
- Caution should be exercised with corticosteroid injections as they may inhibit healing and reduce tendon tensile strength 1
Treatment Algorithm
Initial Phase (0-6 weeks)
- Begin with exercise therapy focusing on rotator cuff strengthening and scapular stabilization 1
- Use NSAIDs for pain control 1, 2
- Implement activity modification to avoid movements that aggravate symptoms 1
If Inadequate Response to Initial Treatment
- Consider a single corticosteroid injection for short-term pain relief 3, 1
- Implement a more intensive physical therapy program 1
- Consider advanced imaging (MRI, ultrasound) to assess for full-thickness tears if symptoms persist 1
For Persistent Symptoms
- Surgical consultation is appropriate for patients with persistent pain and functional limitations despite 3-6 months of conservative management 1
Evidence for Conservative Management
- Multiple studies support that most rotator cuff tendinitis cases can be managed successfully without surgical intervention 4
- Limited evidence suggests that surgery is not more effective in treating rotator cuff tears than conservative treatment alone 5
- There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving functional scores or reducing pain 5
Common Pitfalls and Caveats
- Overreliance on corticosteroid injections may lead to tendon weakening and potential rupture 1
- Neglecting exercise therapy, which forms the cornerstone of conservative management, is a common mistake in treatment 1
- Early presentation and addressing the condition promptly leads to better outcomes 6
- Dominant arm involvement is associated with a poorer prognosis 6
- A sizeable proportion of patients may develop chronic tendinitis resistant to conservative treatment, suggesting that rotator cuff tendinitis is not always self-limiting 6