What’s New in Rotator Cuff Tendinopathy Care? Insights from the 2025 Clinical Guidelines

Shoulder pain can be a real pain in the… well, shoulder. And if you or someone you know has been dealing with rotator cuff tendinopathy, you’ll know just how frustrating it can be.

The good news? The latest clinical practice guidelines are in—and they offer a clear, evidence-based approach to help people recover better and get back to doing what they love.

I’ll walk you through the highlights from the 2025 Clinical Practice Guideline for Rotator Cuff Tendinopathy, published in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), developed by an international team of health professionals. Whether you’re a patient, a clinician, or someone who’s just curious about shoulder pain, there’s something in here for you.

First things first: What is rotator cuff tendinopathy?

The rotator cuff is a group of four muscles—the supraspinatus, infraspinatus, subscapularis, and teres minor—that help stabilise and move your shoulder. Rotator cuff tendinopathy is an umbrella term used to describe pain and dysfunction in these tendons—whether from overuse, age-related changes, or injury. Sometimes the tendons are inflamed, sometimes there are partial tears, and sometimes tiny calcium deposits sneak in (this is called calcific tendinopathy).

Rotator Cuff Anatomy. Source: Ace Healthcare

How Should it be Assessed?

Here’s where things often go wrong. Many people are sent off for scans straight away—but that’s not always necessary (or helpful).

Instead, the guidelines recommend:

• A detailed history: not just the pain, but your work, hobbies, goals, and any psychosocial stressors.

• A thorough physical exam: checking movement, strength, posture, and ruling out other causes.

• Use of simple tools like goniometers or smartphone apps to measure range of motion (instead of just eyeballing it).

• Handheld dynamometers to test muscle strength.

• Minimal imaging unless symptoms persist for more than 12 weeks—when needed, ultrasound is the preferred first choice.

And if you're a clinician reading this—don't skip red flag checks and psychosocial risk factors. They can change the course of care dramatically.

Here's the Gist:

• Paracetamol and NSAIDs (like ibuprofen) can help in the short term.

• Corticosteroid injections may offer short-term relief, but they’re not a first-line treatment. If you do use them, ultrasound guidance is best.

• Opioids? Only for severe cases that don’t respond to other options—and even then, used with caution.

• Fancy injections like platelet-rich plasma (PRP) or hyaluronic acid aren’t recommended as first-line treatments either.

  
  

  

  Rotator Cuff Tendinopathy Medication Guidelines. Sourced by: ChatGPT

Rehabilitation is the Game-Changer:

If there’s one thing this guideline makes clear, it’s this: active rehab is your best bet.

• Start with individualised education—helping people understand their pain and what they can do about it.

• Then, move into progressive exercise, tailored to each person’s stage of recovery. Resistance training, motor control, and shoulder-specific loading all have their place.

• Manual therapy can help reduce pain in the short term, especially when paired with exercise.

• Other tools like taping, acupuncture, and laser therapy? They might help some people—but they’re not magic bullets.

• Ultrasound therapy? Skip it. The evidence just isn’t there.

  
  

Rotator Ciff Muscles. Sourced by: Wix

What about returning to sport?

For athletes (elite or weekend warriors), the message is clear:

• Focus on capacity and load tolerance—not just pain levels.

• Build a return-to-sport plan that includes functional testing, strength benchmarks, and psychological readiness.

• Use validated outcome measures to track progress.

In other words: don’t rush it, but don’t avoid it either. The shoulder likes to move—and a gradual return is usually the way to go.

Why do these guidelines matter?

One of the most exciting things about this update is how strongly it supports evidence-informed, patient-centred care. It’s not about throwing everything at the wall to see what sticks. It’s about doing the things that actually help—and avoiding the things that don’t.

That means: ✔️ Less overmedicalising ✔️ More active involvement from the patient ✔️ A team-based approach grounded in education, movement, and long-term function

Sourced by: ChatGPT

Final thoughts

Rotator cuff tendinopathy can be tricky—but it doesn’t have to be overwhelming. With the right assessment, the right education, and a thoughtful rehab plan, recovery is absolutely achievable.

If you’re dealing with shoulder pain and wondering what your next step should be, feel free to reach out. I’d love to help you move with confidence again.

References:

Desmeules, F., Roy, J. S., MacDermid, J. C., Hébert, L. J., Faber, K. J., Leroux, M., ... & Michener, L. A. (2025). Rotator cuff tendinopathy diagnosis, nonsurgical medical care, and rehabilitation: A clinical practice guideline. Journal of Orthopaedic & Sports Physical Therapy, 55(4), 235–274. https://doi.org/10.2519/jospt.2025.13182