From the Guidelines
Treatment for rotator cuff tendinitis should primarily involve a combination of rest, medication, physical therapy, and gradual return to activity, with surgery considered only if symptoms persist despite 6+ months of appropriate conservative treatment. The initial approach should include reducing activities that cause pain and avoiding overhead movements that stress the shoulder. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) can be used for 1-2 weeks to reduce pain and inflammation 1. Applying ice to the affected shoulder for 15-20 minutes several times daily, especially after activity, can also help. Physical therapy is crucial and should include specific exercises to strengthen the rotator cuff muscles and improve shoulder mobility; these typically include internal and external rotation exercises, scapular stabilization, and gentle stretching 1. A typical program might last 6-8 weeks with 2-3 sessions per week.
For persistent pain, the use of corticosteroid injections is a consideration, although the evidence for its effectiveness in rotator cuff tears is inconclusive 1. However, given the potential benefits in reducing inflammation and pain, it may be considered on a case-by-case basis. The natural history of overuse tendinopathies, including rotator cuff tendinitis, suggests that most patients (about 80%) fully recover within three to six months with appropriate outpatient treatment, which includes relative rest, icing, and eccentric strengthening exercises 1.
Key points to consider in the treatment of rotator cuff tendinitis include:
- Reducing pain and inflammation through the use of NSAIDs and ice
- Implementing a physical therapy program to strengthen the rotator cuff and improve shoulder mobility
- Considering corticosteroid injections for persistent pain, despite the inconclusive evidence regarding their effectiveness in rotator cuff tears
- Reserving surgery for cases where symptoms persist despite 6+ months of conservative treatment, as it is an effective treatment option for such cases 1.
From the Research
Treatment Options for Rotator Cuff Tendinitis
- Conservative management is a viable option for treating rotator cuff tendinitis, including physical therapy, platelet-rich plasma (PRP) injections, collagen injections, hyaluronic acid (HA) injections, and corticosteroid injections 2, 3.
- Physical therapy should focus on restoring range of motion, addressing stiffness, and restoring motor control and strength to the scapula and rotator cuff 2.
- Corticosteroid injections may provide short-term pain relief and improvement in function, especially when combined with physical therapist interventions 4, 5.
- Oral non-steroidal anti-inflammatory drugs (NSAIDs) can provide short-term pain relief, but their efficacy in improving function is limited 6.
- The effectiveness of corticosteroid injections compared to physical therapist interventions alone is still uncertain, with some studies suggesting that injections may not be more effective than physical therapy in the long term 4.
Comparison of Treatment Options
- Corticosteroid injections may be more effective than NSAIDs in providing pain relief and improving function in the short term 5, 6.
- Physical therapist interventions, including exercise and physical therapy, may be an important stand-alone treatment option for rotator cuff tendinitis, especially considering the potential adverse events associated with injections 4.
- The combination of corticosteroid injections and physical therapist interventions may result in better outcomes than either treatment alone 4, 3.
Efficacy of Treatment Options
- The evidence for the efficacy of corticosteroid injections and physical therapist interventions is mostly of moderate to very low certainty 4.
- High-quality research is needed to determine the effectiveness of different treatment options for rotator cuff tendinitis, including the use of core outcomes and long-term follow-up assessments 4, 3.