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Tear vs. Tendinitis: What’s Your Shoulder Telling You?

Why Does Your Shoulder Hurt?

You reach for something on a high shelf, and pain shoots through your shoulder. Or maybe there's just a dull ache that never quite goes away. These symptoms often indicate a rotator cuff injury, a term many hear but few fully understand.

Most rotator cuff problems fall into two categories: rotator cuff tendinitis or a rotator cuff tear. Knowing which one you have is critical. This guide explains the differences, their causes, symptoms, and treatment options.

This is general medical information. A proper diagnosis from a healthcare professional is essential for appropriate treatment.

What Is Rotator Cuff Tendinitis?

Rotator cuff tendinitis is inflammation of the shoulder tendons, not a tear. The tendons become irritated, swollen, and painful from overuse, not from a rip.

What Causes Rotator Cuff Tendinitis?

These factors commonly trigger tendinitis:

  • Repetitive overhead movements: e.g. painting, swimming, tennis

  • Poor posture: narrows the shoulder space and compresses tendons

  • Ageing: natural wear and tear causes tendon breakdown

What Are the Symptoms of Tendinitis?

Common symptoms include:

  • A dull ache deep inside the shoulder

  • Pain that worsens at night or when lying on the affected side

  • Discomfort when reaching behind your back or lifting your arm

  • Mild weakness in the shoulder

Key Difference: Tendinitis pain is often persistent and dull, while a tear usually causes sudden, sharp pain.

What Is a Rotator Cuff Tear?

A rotator cuff tear means one or more of the tendons have partially or fully ripped. This is more serious than inflammation and often needs different treatment.

Two Types of Tears

  1. Acute Tear

    • Caused by a sudden injury

    • Common during falls or lifting something heavy

  2. Degenerative Tear

    • Caused by gradual wear and tear over time

    • Often begins as untreated tendinitis

What Are the Symptoms of a Rotator Cuff Tear?

  • Sharp pain at the moment of injury (acute tears)

  • Significant arm weakness that makes lifting difficult

  • A snapping or cracking sound or feeling when moving the shoulder

  • Constant pain, often worse than tendinitis

Ignoring tendinitis can lead to a degenerative tear. Avoid pushing through shoulder pain or repeating movements that aggravate it.

How Are These Conditions Diagnosed?

Self-diagnosis is unreliable. Only a trained clinician can confirm whether it’s tendinitis or a tear.

Physical Examination

A doctor will:

  • Check your range of motion

  • Test muscle strength

  • Use specific arm positions to locate the pain source

Imaging Tests

Test TypePurposeWhen Used
UltrasoundReal-time view of tendon movementDetects both inflammation and tears; used at RAD Clinics
MRIHigh-detail image of soft tissueConfirms tear size and severity

Misdiagnosis Risk: Frozen Shoulder

Confusion may arise between adhesive capsulitis (frozen shoulder) and rotator cuff tendinitis.

ConditionMain Feature
Frozen shoulderStiffness and limited movement in all directions
TendinitisPain is tied to specific arm movements, not full-range stiffness

What Are the Treatment Options?

Non-Surgical Treatments (Tendinitis + Small Tears)

  • Rest & Activity Change

    • Avoid movements that worsen symptoms

  • Physiotherapy

    • Exercises target strength and flexibility

    • Focus on scapular control and rotator cuff mechanics

  • Medication

    • Over-the-counter NSAIDs (e.g., ibuprofen) reduce inflammation

  • Ultrasound-Guided Cortisone Injections

    • Delivers precise, powerful relief

    • RAD Clinics offers targeted treatment for faster recovery

Physiotherapy combined with ultrasound-guided injections often prevents progression to a tear.

Surgical Treatments (Large or Acute Tears)

Surgery is advised when:

  • The tear is severe

  • Conservative treatments fail

Goal: Reattach the tendon to the bone using sutures or anchors.

Recovery TimeType
TendinitisA few weeks to months
Tear SurgerySeveral months of rehab

Rotator Cuff Tendinitis vs Tear: Quick Comparison Table

FeatureTendinitisTear
Type of InjuryInflammationPartial or full tendon rip
PainDull, persistentSharp, sudden or constant
WeaknessMildSignificant
CauseOveruse, posture, and ageSudden injury or chronic degeneration
TreatmentNon-surgicalMay require surgery
ImagingUltrasound or MRIMRI preferred
RecoveryWeeks to monthsMonths post-surgery

Don't Guess. Get Assessed.

Tendinitis is inflammation. A tear is a physical rupture. The symptoms, especially pain type, weakness, and movement limitations,   offer clues, but only a professional can provide certainty.

If you're dealing with shoulder pain that isn't improving, early intervention makes a difference. A proper diagnosis helps prevent more serious damage and speeds up recovery.

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Location: Milton Keynes, UK

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