Inclusion Criteria:  Adult patients diagnosed with RA according to 2010 (American College of Rheumatology)(ACR)/European League Against Rheumatism (EULAR) Classification Criteria for RA Patients diagnosed with rotator cuff tendinopathy based on clinical and musculoskeletal Ultrasonography (MSUS) finding. Patient complaining of shoulder pain for at least 3 months Positive jobs test or hornblower sign or left off test Age ranged from 18 to 50 years.  Exclusion Criteria:  Patient indicated for surgical repair of rotator cuff Patient with previous shoulder surgery. Patient with history of intra-articular shoulder fracture. Patient with history of shoulder dislocation Diabetes mellitus