Rotator Cuff Tendinopathy: A Clinician’s Guide to Evidence-Based Assessment and Rehabilitation
By: Hamza Adwan, MScPT candidate; Editor: Maggie Bergeron, MScPT, Embodia Co-Founder ∙ Estimated reading time: 3 minutes

RC: Most common and most stubborn, so what to do?

Rotator cuff (RC) tendinopathy is one of the most common—and often most stubborn—causes of shoulder pain. It affects people from all walks of life, from athletes to office workers, and can persist for months if not properly managed. 

Without appropriate intervention, ongoing shoulder load can lead to prolonged discomfort and functional limitations.

Fortunately, clinicians are not alone in navigating the complex treatment landscape.

The 2025 Clinical Practice Guideline (CPG), developed by Dr. Marc-Olivier Dubé and colleagues, offers a clear, evidence-based roadmap for managing rotator cuff tendinopathy. 

In this blog, we’ll explore the key takeaways from this guideline to help physiotherapists and other allied healthcare providers deliver effective, modern care.

📚 Explore the full Rotator Cuff Tendinopathy: Diagnosis, Medical Care & Rehab course on Embodia Academy by following the link below:

Explore the full course on Embodia

What is this guideline based on?

The CPG is rooted in high-quality systematic reviews and randomized trials. 

Each recommendation is graded from A (strong evidence) to F (expert opinion) and is shaped by insights from clinicians, surgeons, and patient partners.

Note: The guideline does not apply to massive RC tears or post-surgical rehab. It serves as a flexible framework—not a rigid protocol—for best practice in nonsurgical RC care.

Assessment: Where clinical expertise meets evidence

A solid assessment is key to identifying rotator cuff tendinopathy and ruling out more serious conditions.

The guideline recommends:

• Thorough subjective history: Duration of pain, psychosocial influences, and co-morbidities all matter.

• Observation and physical exam: Look for atrophy, deformities, swelling, and test range of motion.

• Red flag screening: Be alert for signs like fever or unexplained weight loss.
  
  

Validated tools to use:

• Goniometer/dynamometer for ROM and strength

• Outcome measures such as QuickDASH, WORC, and SPADI
  
  

❌ Avoid early imaging

Routine imaging (like MRI) is not recommended within the first 12 weeks as it can lead to overdiagnosis and unnecessary treatment.

If imaging becomes necessary, ultrasound is just as effective and more cost-efficient.

Medical care: Relief without reliance

For non-surgical symptom relief, the CPG suggests:

• Paracetamol and NSAIDs: May help in the short term

• Opioids: Only for severe cases, and only in the short term

• Corticosteroid injections: Not first-line, but can provide short-term benefit if ultrasound-guided
  
  

For calcific tendinopathy, interventions such as barbotage or shockwave therapy may be beneficial, although the evidence is still limited.

❌ Avoid

PRP, stem cell therapy, and prolotherapy: No strong evidence supports these.

Rehabilitation: Active care is the gold standard

When it comes to long-term recovery, exercise therapy and education are essential.

The guideline recommends:

• Educating patients on:

• Pain mechanisms

• Activity pacing

• Sleep and stress management

• Prioritizing motor control and progressive resistance exercises

• Tailoring exercise programs to individual goals

• Encouraging compliance - supervised and unsupervised rehab are equally effective when patients stay engaged
  
  

Additional interventions

• Manual therapy: May reduce short-term pain when combined with exercise

• Taping: Mixed evidence - may work short-term for some

• Modalities: Laser (weak evidence); avoid therapeutic ultrasound unless for calcific cases

• Ergonomics also plays a role - workplace adaptations can support recovery in both manual labour and sedentary environments.

Return to sport or activity: Keep it individualized 

There are two simple but crucial recommendations:

1. Assess physical capacity and load tolerance

2. Use patient-reported outcome tools to gauge psychological readiness
   
   

Final takeaways for clinicians

✅  Combine subjective history, validated tools, and patient-centred goals

✅  Prioritize active rehab, education, and short-term pain relief

❌  Avoid low-value interventions like early imaging or routine injections

📖 Stay up-to-date and tailor your approach to each patient

Ready to deepen your clinical knowledge?

Access the full guideline and course by Dr. Marc-Olivier Dubé below:

Access the Rotator Cuff Tendinopathy Course 

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Date written: 9 June 2025
Last update: 26 June 2025