Rotator cuff tendinopathy is painful, load-related dysfunction of the rotator cuff tendons, most often supraspinatus, and is the commonest cause of shoulder pain in adults, peaking between 40 and 60.
It is often grouped with subacromial bursitis as rotator cuff related shoulder pain (RCRSP) or subacromial pain, terms that reflect a tendon problem rather than mechanical impingement. Repetitive overhead and occupational load are common contributors.
Most cases settle with education and exercise-based rehabilitation, usually within 3 months. Imaging and surgery have a limited role in a typical presentation.
The rotator cuff comprises supraspinatus, infraspinatus, teres minor and subscapularis (SITS). Supraspinatus passes beneath the coracoacromial arch and is by far the most commonly affected tendon.
Current understanding favours an intrinsic model: age-related change within the tendon, with disorganised collagen, altered cellularity and neovascularisation. The critical zone of relative hypovascularity, 1 to 2 cm from the supraspinatus insertion, is the typical site. Extrinsic factors such as acromial spurs and bursal thickening may contribute but are not the main driver, which is why the term subacromial impingement is falling out of use.
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