{"id":26195,"date":"2025-10-31T22:00:00","date_gmt":"2025-10-31T21:00:00","guid":{"rendered":"https:\/\/www.physiotutors.com\/?p=26195"},"modified":"2025-12-01T16:45:00","modified_gmt":"2025-12-01T15:45:00","slug":"rotator-cuff-tendinopathy-the-new-2025-clinical-practice-guideline","status":"publish","type":"post","link":"https:\/\/www.physiotutors.com\/rotator-cuff-tendinopathy-the-new-2025-clinical-practice-guideline\/","title":{"rendered":"Rotator Cuff Tendinopathy: The New 2025 Clinical Practice Guideline"},"content":{"rendered":"\n<p>Rotator cuff-related shoulder pain is one of the most common musculoskeletal complaints presenting in primary care and physiotherapy clinics. Yet, overmedicalization, inconsistent assessment strategies, and reliance on imaging remain widespread. <\/p>\n\n\n\n<p>The 2025 Clinical Practice Guideline by Desmeules et al., published in the Journal of Orthopaedic &amp; Sports Physical Therapy, delivers a comprehensive and evidence-based overview for the diagnosis,<br>non-surgical management, and rehabilitation of adults with rotator cuff tendinopathy (RCT). This article summarizes the key updates and takeaways from the 2025 guideline, helping clinicians apply them with confidence and clarity in everyday practice.<\/p>\n\n\n<div class=\"quote-with-background\" style=\"\">\n    <div class=\"quote-with-background__in\">\n\n        <svg width=\"30px\" height=\"25px\" viewBox=\"0 0 30 25\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n                <g id=\"08-blog-redesign\" transform=\"translate(-191.000000, -2974.000000)\" fill=\"#7973FF\" fill-rule=\"nonzero\">\n                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">\n                        <g id=\"\u201c\" transform=\"translate(111.000000, 81.000000)\">\n                            <path d=\"M6.4,25 C4.42666667,25 2.86666667,24.3743344 1.72,23.1230032 C0.573333333,21.871672 0,20.2609159 0,18.2907348 C0,17.2790202 0.173333333,16.2539936 0.52,15.215655 C0.866666667,14.1773163 1.49333333,12.513312 2.4,10.2236422 L6.48,0 L12.8,0 L10,12.5399361 C11.9733333,14.0841321 12.96,16.001065 12.96,18.2907348 C12.96,20.2076677 12.3466667,21.8051118 11.12,23.0830671 C9.89333333,24.3610224 8.32,25 6.4,25 Z M23.44,25 C21.4666667,25 19.9066667,24.3743344 18.76,23.1230032 C17.6133333,21.871672 17.04,20.2609159 17.04,18.2907348 C17.04,17.2790202 17.2133333,16.2539936 17.56,15.215655 C17.9066667,14.1773163 18.5333333,12.513312 19.44,10.2236422 L23.52,0 L29.84,0 L27.04,12.5399361 C29.0133333,14.0841321 30,16.001065 30,18.2907348 C30,20.2076677 29.3866667,21.8051118 28.16,23.0830671 C26.9333333,24.3610224 25.36,25 23.44,25 Z\" id=\"Shape\"><\/path>\n                        <\/g>\n                    <\/g>\n                <\/g>\n            <\/g>\n        <\/svg>\n       <div class=\"quote-with-background__content heading-three\">\n            <p>The 2025 Clinical Practice Guideline delivers a comprehensive and evidence-based overview for the diagnosis, non-surgical management, and rehabilitation of adults with rotator cuff tendinopathy.<\/p>\n       <\/div>\n       <div class=\"quote-with-background__info\">\n                   <\/div>\n    <\/div>\n<!--    <div class=\"quote-with-background__background\">-->\n<!--        <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 849 447\" version=\"1.1\" preserveAspectRatio=none xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">-->\n<!--            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">-->\n<!--                <g id=\"08-blog-redesign\" transform=\"translate(-80.000000, -2893.000000)\" fill=\"#F1F5FD\">-->\n<!--                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">-->\n<!--                        <polygon id=\"Rectangle\" transform=\"translate(424.500000, 223.500000) scale(-1, 1) translate(-424.500000, -223.500000) \" points=\"0 99.703192 849 -4.43831367e-13 849 347.296808 0 447\"><\/polygon>-->\n<!--                    <\/g>-->\n<!--                <\/g>-->\n<!--            <\/g>-->\n<!--        <\/svg>-->\n<!--    <\/div>-->\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Why This Guideline Matters<\/h2>\n\n\n\n<p>Developed by an international team of experts across physiotherapy, orthopaedics, and physical medicine, the clinical practice guideline is grounded in systematic reviews, patient involvement, and rigorous methodological standards. Backed by the Quebec Rehabilitation Network (REPAR), Quebec Pain Research Network (QPRN), and the Academy of Orthopaedic Physical Therapy (AOPT) of the American Physical Therapy Association (APTA), it consolidates the best available evidence for clinicians worldwide. With eight patient representatives from three countries involved in the revision process, this guideline also reflects the lived experience and preferences of those receiving care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Evidence Grades Explained<\/h2>\n\n\n\n<p>Each recommendation in the clinical practice guideline is assigned a grade reflecting the strength and certainty of the supporting evidence:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Grade A<\/strong> \u2013 Strong evidence: Supported by multiple high-quality randomized controlled trials (RCTs) or systematic reviews.<\/li>\n\n\n\n<li><strong>Grade B<\/strong> \u2013 Moderate evidence: Supported by at least one high-quality RCT or several lower- quality RCTs or cohort studies.<\/li>\n\n\n\n<li><strong>Grade C<\/strong> \u2013 Weak evidence: Based on single studies of lower quality or expert consensus where research is limited.<\/li>\n\n\n\n<li><strong>Grade D<\/strong> \u2013 Conflicting evidence: Studies disagree in their findings.<\/li>\n\n\n\n<li><strong>Grade E<\/strong> \u2013 Theoretical\/foundational: Based on cadaveric, biomechanical, or animal research.<\/li>\n\n\n\n<li><strong>Grade F<\/strong> \u2013 Expert opinion: Based on best practices and clinical consensus in the absence of empirical evidence.<\/li>\n<\/ul>\n\n\n<div class=\"cta\" style=\"\">\n    <div class=\"cta__in\">\n        <div class=\"left\">\n            <div class=\"cta__content text-color-light\">\n\t\t\t\t\t\t\t\t\t<h2 class=\"own-size\">Rotator Cuff Related Shoulder Pain<\/h2>\n\t\t\t\t\t                <p>Gain the confidence and expertise to effectively manage rotator cuff-related shoulder pain in your patients with Filip Struyf. You\u2019ll be equipped with the tools and knowledge to enhance shoulder function, reduce pain, and improve quality of life for your patients.<\/p>\n                                        <div class=\"cta__button\">\n                                <a href=\"https:\/\/study.physiotutors.com\/course\/rotator-cuff-related-shoulder-pain?_gl=1*1sxeo8a*_gcl_au*MTkwNzcwMDY5MS4xNzU2NDU5MzU3LjExNTQ1MTgxNDMuMTc2MTY1MzcwNS4xNzYxNjU0MzY0\" class=\"button button-five\" target=\"_self\">\n                                    Course Details                                <\/a>\n                            <\/div>\n                                    <\/div>\n        <\/div>\n                        <div class=\"right\">\n                    <img decoding=\"async\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/04\/Rotator-cuff-related-shoulder-pain.jpg\" alt=\"\"\/>\n                <\/div>\n                <\/div>\n<\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Key Clinical Recommendations<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">1. Assessment &amp; Diagnosis<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Comprehensive Subjective History (Grade F)<\/strong>: Clinicians must include a thorough patient history considering age, gender, hand dominance, job demands, sport activities, medication use, comorbidities, psychosocial influences, mechanism of injury, previous treatments, current symptoms (pain, range of motion [ROM] limitation, weakness), and patient goals.<\/li>\n\n\n\n<li><strong>Physical Assessment (Grade F)<\/strong>: Should include inspection for deformity, muscle atrophy, and swelling; measurement of active\/passive ROM and strength; and optional palpation and special tests based on clinical reasoning. Cervical spine should be screened to rule out referred pain.<\/li>\n\n\n\n<li><strong>Red Flags<\/strong> <strong>(Grade F)<\/strong>: Clinicians must screen for serious pathologies such as infection, cancer, cardiovascular conditions, or systemic involvement. Prognostic Factors (Grade B): Identification of personal, clinical, and work-related factors affecting prognosis is recommended to guide individualized care plans.<\/li>\n\n\n\n<li><strong>Special Tests (Grade B)<\/strong>: Painful arc test can help confirm diagnosis, while the Hawkins-Kennedy test can assist in ruling it out.<\/li>\n\n\n\n<li><strong>Objective Measures (Grades A)<\/strong>: ROM should be measured using a goniometer, inclinometer, or validated smartphone application. Scapular ROM is unreliable and not recommended. Strength testing should be performed using a handheld dynamometer.<\/li>\n\n\n\n<li><strong>Patient-Reported Outcome Measures (Grade A)<\/strong>: Use validated, reliable, and responsive tools such as the Shoulder Pain and Disability Index (SPADI) or the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to track pain and disability.<\/li>\n\n\n\n<li><strong>Imaging (Grades F)<\/strong>: Should not be used initially. Diagnostic ultrasound is preferred if imaging is needed after 12 weeks of failed conservative care. Magnetic Resonance Imaging (MRI) is not routinely recommended. Discuss pros\/cons of imaging openly with patients.<\/li>\n\n\n\n<li><strong>Referral (Grade F)<\/strong>: Patients with persistent and severe symptoms after 12 weeks of care should be referred to a musculoskeletal specialist (e.g., sports physician, physiatrist, or orthopedic surgeon).<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">2. Pharmacological Treatment<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Acetaminophen (Grade C)<\/strong>: May be recommended for short-term pain relief. Non-Steroidal<\/li>\n\n\n\n<li><strong>Anti-Inflammatory Drugs (NSAIDs) (Grade B)<\/strong>: Effective for short-term pain management.<\/li>\n\n\n\n<li><strong>Opioids (Grades F\/C)<\/strong>: Should not be used as first-line treatment. May be considered short-term in severe cases where other options are ineffective or contraindicated. Requires regular risk reassessment.<\/li>\n\n\n\n<li><strong>Corticosteroid Injections (Grades B\/C)<\/strong>: May be used for short-term pain relief but not as a first-line intervention. Ultrasound guidance is recommended if injections are given.<\/li>\n\n\n\n<li><strong>Calcific Lavage (Grade B)<\/strong>: Recommended for calcific tendinopathy that is unresponsive to initial treatments.<\/li>\n\n\n\n<li><strong>Platelet-Rich Plasma (PRP) &amp; Hyaluronic Acid (Grades D\/F)<\/strong>: May be considered<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Rotator Cuff Related Shoulder Pain | Physiotherapy Guideline Review\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/7qclKHXElEE?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">3. Rehabilitation Principles<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Education (Grade C)<\/strong>: Clinicians should educate patients on their condition, activity modification, pain neuroscience, prognosis, and self-management strategies. Tailor communication to the level of literacy and psychosocial context.<\/li>\n\n\n\n<li><strong>Exercise Therapy (Grade A)<\/strong>: Core intervention. Should include progressive resistance training and motor control exercises. Individualize based on pain tolerance and patient goals.<\/li>\n\n\n\n<li><strong>Manual Therapy (Grade B)<\/strong>: May reduce pain short-term when used with exercise. Techniques include soft tissue work and joint mobilizations\/manipulations.<\/li>\n\n\n\n<li><strong>Taping (Grade D)<\/strong>: Can be used adjunctively to reduce pain short-term.<\/li>\n\n\n\n<li><strong>Acupuncture (Grade C)<\/strong>: May offer additional short-term benefits when combined with active rehab.<\/li>\n\n\n\n<li><strong>Shockwave Therapy (Grade C)<\/strong>: Useful in calcific tendinopathy. Not recommended in non-calcific RCT.<\/li>\n\n\n\n<li><strong>Laser Therapy (Grade C)<\/strong>: May reduce pain in calcific tendinopathy.<\/li>\n\n\n\n<li><strong>Therapeutic Ultrasound (Grades C\/B)<\/strong>: Not recommended for either calcific or non-calcific RCT due to lack of benefit.<\/li>\n\n\n\n<li><strong>Ergonomic Modifications (Grade C)<\/strong>: May help reduce occupational stress on the shoulder.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">4. Return to Sport<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Load Tolerance (Grade F)<\/strong>: Return-to-sport plans should be based on athlete\u2019s ability to tolerate shoulder and rotator cuff loading.<\/li>\n\n\n\n<li><strong>Outcome Measures (Grade F)<\/strong>: Use validated tools to assess pain, disability, readiness to return, and functional performance. Examples include sport-specific performance tests and return-to-sport checklists.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Summary<\/h2>\n\n\n\n<p>The 2025 Clinical Practice Guideline for rotator cuff tendinopathy delivers a clear and comprehensive framework for conservative shoulder care. It prioritizes individualized assessment based on patient history and clinical examination, discourages early imaging, and supports objective measurement tools for range of motion and strength. Pharmacological interventions are secondary to active rehabilitation, with exercise therapy positioned as the cornerstone of recovery. Adjunct therapies like manual therapy, taping, and acupuncture may be considered selectively. The guideline also highlights the importance of patient-centered education and gradual, load-based return-to-sport programming. Overall, it encourages clinicians to rely less on diagnostic imaging and passive modalities, and more on active, evidence-informed strategies that empower patients.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Changes from the 2022 guideline:<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Integration of systematic reviews up to October 2023.<\/li>\n\n\n\n<li>New recommendations specifically addressing return to sport.<\/li>\n\n\n\n<li>Clearer grading of evidence using GRADE-adapted methodology.<\/li>\n\n\n\n<li>Enhanced patient-centered language and prioritization of shared decision-making.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">The Rotator Cuff Management Decision Tree<\/h2>\n\n\n\n<p>The authors provided an additional decision tree that guides clinicians in their patients process of rehabilitation from rotator cuff tendinopathy.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"4151\" height=\"3145\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2025\/10\/RCT_Decision-Tree_Desmeules-et-al-2025.jpeg\" alt=\"Rct decision tree desmeules et al 2025\" class=\"wp-image-26198\" \/><figcaption class=\"wp-element-caption\">Management of Rotator Cuff Tendinopathy decision tree. The symbol # represents the associated recommendation number (outlined in the paper). Grade letters indicate that the guidelines are based on (A) strong evidence, (B) moderate evidence, (C) weak evidence, (D) conflicting evidence, (E) theoretical\/foundational evidence, or (F) expert opinion.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Limitations &amp; Conclusion<\/h2>\n\n\n\n<p>While this guideline is extensive, some areas, such as return to sport timelines and PRP effectiveness, still lack high-quality RCTs. Further research is needed to individualize treatment and identify prognostic subgroups. The 2025 Rotator Cuff Tendinopathy CPG offers an evidence-based, patient-centered approach that can reduce overtreatment and improve clinical outcomes. By aligning practice with these recommendations, clinicians can more confidently assess, educate, and rehabilitate adults with RCT.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Reference<\/h2>\n\n\n\n<p>Desmeules, F., Roy, J-S., Lafrance, S., et al. (2025). Rotator Cuff Tendinopathy Diagnosis, Non-Surgical Medical Care and Rehabilitation: A Clinical Practice Guideline. Journal of Orthopaedic &amp; Sports Physical Therapy. https:\/\/doi.org\/10.2519\/jospt.2025.13182<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":42604,"featured_media":26204,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"20295,26021,8188,22761,17432,5136","_relevanssi_noindex_reason":"","footnotes":""},"categories":[197,280,186,2144],"tags":[919,1809,1801,2292],"tracking_tag":[],"class_list":["post-26195","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-education-career","category-muscle-tendon","category-shoulder","category-sports-rtp","tag-rehabilitation","tag-rotator-cuff","tag-rotator-cuff-rehab","tag-sport-injuries"],"acf":{"sections":null},"yoast_head":"<!-- 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