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Shoulder pain is a common nuisance that you may not even think about until you reach overhead for your favorite coffee mug and, ouch, there it is! Pain that suddenly starts to interfere with routine habits like brushing your teeth, drying your hair, or reaching overhead. If this sounds familiar, it’s time to speak with your doctor.

While there are a number of potential causes for shoulder pain, two of the most common sources are attributed to either a tear to the rotator cuff, or tendonitis. What’s the difference? Let’s take a closer look.

Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It provides the range of motion you need to lift your arm and reach upward. It is one of the most important parts of your body and gets a lot of use, which is why millions of people suffer from problems related to it.

Rotator cuff tendonitis – the inflammation of key tendons in the shoulder – is the most common cause of shoulder pain. It’s usually a gradual progression of an irritation to the area. This condition can occur when you have loose joints, abnormal bony anatomy, perform heavy, repetitive lifting above the shoulder, or are an athlete who performs sports that require frequent overhead reaching. It can also be associated with a sudden injury to the area, or calcium build up in the rotator cuff tendons.

Symptoms of rotator cuff tendonitis are usually mild to begin with and can include:

  • Audible clicking when using the shoulder.
  • Shoulder pain when reaching or lifting.
  • Pain, swelling, or tenderness in the front side of the shoulder.
  • Pain when the shoulder is still.
  • Stiffness.

A rotator cuff tear occurs when one or more of the tendon’s attachments to the arm’s humorous bone rips, or possibly even severs. It can be the result of a single incident where you experience an impact to the shoulder while outstretched, or it can also be the result of a degenerative tear. A degenerative tear is where the tendons in the rotator cuff deteriorate over time. This type of tear usually develops due to multiple factors like repetitive shoulder movements, aging, inadequate blood supply, and bone spurs.

In either of these cases, there are two types of tears – a partial tear or a full thickness tear. A partial tear causes damage to the tendon, but does not create complete severance. A full thickness tear completely separates the tendon from the bone and is more likely to require surgery.

Symptoms of a rotator cuff tear may include:

  • Pain when not using the shoulder.
  • Pain when going to sleep, especially if lying on the affected shoulder.
  • A crackling or popping feeling upon moving the shoulder in specific ways.
  • Feeling weakness when trying to lift objects or rotate the arm.


Although both a tear to the rotator cuff and tendonitis have similarities, identifying the source of your symptoms is the first step towards treatment. To properly diagnose your condition, your health care practitioner will likely discuss your medical history and perform a physical examination of your shoulder. Often, your doctor will also request medical imaging to help get a better look at the area of concern. These exams could include an X-ray, ultrasound, or magnetic resonance imaging (MRI).

  • X-ray – A shoulder X-ray can look at the bones of the shoulder to rule out fractures, or it can look for calcium deposits or bone spurs in and around the shoulder.
  • Musculoskeletal (MSK) shoulder ultrasound – An MSK ultrasound can examine the cartilage, muscles, tendons, and ligaments in the shoulder to look for fluid or signs of inflammation. The dynamic nature of this exam is an advantage for accurate diagnosis because it can evaluate your shoulder in motion as you perform the actions that are causing the pain. This exam will be performed in conjunction with an X-ray.
  • MRI – Magnetic resonance imaging is a powerful tool for screening and diagnosis. It’s non-invasive, uses no radiation, and is helpful in diagnosing some of the most difficult joints in your body like the shoulder. It can provide invaluable information about the bones and tissues around your shoulder, such as the cartilage, ligaments, and tendons. MRI is often ordered when more detail is needed or the cause of symptoms is unclear on other types of imaging.


If you experience lingering pain in your shoulder that interferes with your day-to-day activities, it’s important to speak with your doctor about it. Whether it’s tendonitis, a rotator cuff tear, or something else, if left untreated the issue can worsen. For example, tears can get larger and more difficult to treat overtime. Discussing your symptoms with your doctor will help identify their cause and determine the best treatment plan for your needs.


Harvard Health Publishing (2018) “Rotator Cuff Injury.” Harvard Medical School, Accessed March 19, 2021.

Johns Hopkins Medicine (2021) “Rotator Cuff Injury.” Accessed March 19, 2021.

OrthoBethesda (2021) “The Difference Between Rotator Cuff Tears and Shoulder Tendonitis.” Accessed March 19, 2021.

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