Rotator Cuff Tendinopathy

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 — most often in 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's gradually breaking down can stay just sore for years, partially tear, or eventually 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's usually no single injury, just a slow buildup over weeks or months
• Sudden, intense flare of pain (with calcific tendinopathy) that may come on overnight and make any shoulder movement excruciating
• Weakness with overhead lifting or rotating the arm outward

Pain on the outside of your shoulder and upper arm, especially when reaching overhead or lifting. Tenderness over the bony bump on the outer shoulder where the tendons attach. Lifting the arm out to the side hurts in the middle of the arc — typically the range 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.

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's very effective for the calcific kind specifically.

2. PRP injection

   An injection of platelet-rich plasma (PRP) — concentrated growth factors drawn from your own blood — placed directly into the damaged tendon is an option for partial tears that haven't quieted with a real rehab program.

Surgery comes into play for two stubborn situations: calcific tendinopathy that won't quiet with needling and rehab, and 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:

• Britannica — Tendinitis
• Britannica — Shoulder (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language