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Muscles of the Shoulder

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Relationship Between Tendon Tissue and Shoulder Disability Change During an 8-Week Exercise Intervention for Rotator

Oscar Vila-Dieguez¹, Matt D Heindel¹, Mark C Zipser¹

¹Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, United States.

Physical Therapy

|August 29, 2025

Summary

Rotator cuff tendinopathy exercise interventions led to improved shoulder function and decreased tendon thickness within two weeks. Internal tendon structure did not change, suggesting early intervention effects.

Keywords:

Mechanisms Patient-reported Outcomes Resistive Exercise Tendon Morphology

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Area of Science:

Orthopedics
Sports Medicine
Rehabilitation Science

Background:

Rotator cuff tendinopathy significantly impacts shoulder function and quality of life.
Understanding the relationship between structural tendon changes and functional recovery is crucial for effective treatment.

Purpose of the Study:

To analyze changes in supraspinatus tendon thickness and internal architecture during an 8-week exercise program.
To determine the association between these tendon alterations and improvements in patient-reported shoulder disability.

Main Methods:

Prospective longitudinal observational study involving 47 adults with rotator cuff tendinopathy.
An 8-week progressive resistive exercise program with bi-weekly supervision.
Ultrasound assessment of supraspinatus tendon thickness and internal architecture (peak spatial frequency radius) at baseline and weeks 2, 4, and 8, alongside the Pennsylvania Shoulder Score.

Main Results:

Significant improvements in the Pennsylvania Shoulder Score were noted at 2, 4, and 8 weeks.
Supraspinatus tendon thickness significantly decreased over the 8 weeks.
No significant changes in internal tendon architecture were observed. A decrease in tendon thickness correlated with improved shoulder scores at 2 weeks.

Conclusions:

Early reductions in tendon thickness correlate with improved shoulder function in the initial two weeks of exercise.
Internal tendon architecture remained stable, indicating it may not be a primary driver of early functional gains.
Further research is needed to explore other factors influencing recovery throughout the intervention period.