Rotator cuff tendonitis can be initiated by an injury or overuse, or there may not be an inciting event at all. Overuse may be related to an increase in the frequency or intensity of weight-lifting, particularly involving pressing movements or a recent increase in overhead activity such as painting the walls at home.

Rotator cuff tendonitis causes pain around the shoulder, most commonly on the outside or lateral part of the shoulder. Pain can often be referred down the arm and even as far as the elbow or below. Less commonly, people have pain in the front or back of the shoulder itself. When the pain related to the rotator cuff is present with activities of daily living, such as getting dressed or lifting light objects, or if the pain causes difficulty with sleep, consultation with a healthcare professional is generally recommended. In some cases magnetic resonance imaging (MRI) of the rotator cuff is helpful to determine if the rotator cuff is torn or if there is another problem in the shoulder.

If the symptoms have only been going on for a few days this problem will often go away on its own. After several weeks or months, patients will generally require anti-inflammatory medication, physical therapy, and time away from lifting to allow the rotator cuff pain to settle down. If these measures don't work, a cortisone injection in the subacromial space will often relieve the symptoms. In other patients, where the above measures do not relieve the pain, surgery for the rotator cuff may be considered to achieve relief. This involves arthroscopic surgery where the inflamed bursal tissue is removed and more room is created for the rotator cuff tendons by using a burr to remove some of the underside of the acromion bone.

After the pain is relieved, the patient can gradually get back to full activities including lifting and sports. The return to activity must be gradual to avoid reoccurrence. I generally recommend that all lifters do some rotator cuff strengthening to avoid this problem. Light external rotation either performed with a cable or a dumbbell while lying on the side (also know as the L-fly) is effective. Prevention is the best cure, and by maintaining a strong rotator cuff this problem may can be headed off before it begins.