supraspinatus tendinitis

what is supraspinatus tendinosis?

Supraspinatus tendinosis, also known as supraspinatus tendinitis or painful arc syndrome, is a prevalent shoulder condition characterized by inflammation and irritation of the supraspinatus tendon. This condition leads to pain, discomfort, and restricted shoulder mobility.

The supraspinatus muscle plays a crucial role in abducting the arm, which means lifting it sideways. The supraspinatus tendon travels between the acromion (a bony projection on the shoulder blade) and the humeral head (the top of the arm bone). When the tendon becomes irritated, it can rub against the acromion, causing friction. Normally, the subacromial bursa, a fluid-filled sac, helps to reduce this friction. However, with persistent strain or excessive workload, the tendon becomes inflamed, leading to tendonitis.

Supraspinatus tendinitis can also occur due to a tear in the supraspinatus tendon. This tear causes a painful arc of movement, especially when lifting the arm sideways, as the tendon impinges on the acromion.

This condition is quite common, particularly among individuals aged 25 to 60. It is frequently observed in athletes participating in sports like baseball and volleyball, as well as people who engage in recreational sports activities on weekends. Additionally, individuals with diabetes are also at a higher risk of developing supraspinatus tendinitis.

difference between supraspinatus tendinitis and supraspinatus tendinopathy

Many people confuse the conditions supraspinatus tendinitis and supraspinatus tendinopathy. Both these pathological conditions affect the shoulder and that is where the similarity of the two ends. While tendinitis is the inflammation of the tendon of the supraspinatus muscle, tendinopathy is a broad term used to describe several supraspinatus tendon injuries like tennis elbow, golfer’s elbow, etc.

The difference between supraspinatus tendinitis and supraspinatus tendinopathy is important as both the conditions have different treatment plan. While supraspinatus tendinitis responds well to anti – inflammation treatment, supraspinatus tendinopathy treatment can be a bit lengthy and is more focussed on improving the strength of the tendon and rebuilding the tissues.

supraspinatus tendinosis symptoms

Subtle cases of supraspinatus tendonitis may go unnoticed initially, but individuals commonly seek medical advice due to shoulder and upper arm pain. Early on, discomfort typically arises during overhead or reaching activities. As the condition progresses, symptoms may include pain at rest, weakness, and stiffness, which can interfere with normal function.

Common signs of Painful Arc Syndrome include:

• Shoulder Pain: A deep ache felt at the top and front of the shoulder, which may radiate down the upper arm and intensify during specific arm movements.
• Painful Arc: Discomfort experienced in a specific range of motion (80-120 degrees) during arm abduction. Pain is usually present within this arc but may be absent outside of this range.
• Shoulder and Arm Weakness: Noticeable weakness in the shoulder and arm, which could indicate a full-thickness rotator cuff tear.
• Functional Limitation: Difficulty performing activities above shoulder height due to pain and restrictions.
• Sleep Disturbance: Nighttime pain, especially when lying on the affected side, can disrupt sleep.
• Full Passive Range of Motion (PROM): Although pain may restrict active movement, passive movement is generally full in cases of pure supraspinatus tendonitis without significant impingement issues.

supraspinatus tendinosis causes

Supraspinatus tendinitis, or Painful Arc Syndrome, is primarily caused by inflammation of the supraspinatus tendons. Several factors contribute to this condition:

1. Repetitive Overhead Activities: Frequent elevation of the arm, such as in sports (e.g., tennis, swimming) or activities like hedge trimming, can lead to tendon irritation.
2. Heavy Work: Repeated heavy lifting overhead, common in professions such as construction or labor, places strain on the tendons.
3. Poor Posture: Extended periods of slouching can reduce the subacromial space, increasing the risk of tendon impingement.
4. Genetic Predisposition: There may be hereditary factors that increase susceptibility to the syndrome.
5. Injury: Trauma, such as falling onto an outstretched hand, can lead to tendon inflammation or damage.
6. Age: As people age, natural wear and tear can narrow the subacromial space, contributing to the development of tendinitis.
7. Primary Shoulder Impingement: Bone spurs or an abnormal shape of the acromion can reduce the subacromial space, leading to increased friction and tendon irritation.
8. Secondary Shoulder Impingement: Dynamic shoulder instability, often due to weakened rotator cuff muscles, can cause poor shoulder control and increased friction on the supraspinatus tendon.

supraspinatus tendinitis treatment

The treatment plan for supraspinatus tendinitis typically starts with self-care measures and the RICE method—rest, ice, compression, and elevation—at home. If these measures do not provide relief, it is important to consult a doctor. The doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. If NSAIDs are ineffective, corticosteroid injections might be considered to provide more substantial pain relief and support healing.

In addition to medication, physiotherapy is often recommended to aid the healing process. Physiotherapy can help improve shoulder function, strengthen the rotator cuff muscles, and alleviate pain through targeted exercises and techniques.

In rare cases, when conservative treatments fail to provide relief, surgery may be considered as a last resort to address structural issues or severe tendon damage.

physiotherapy for supraspinatus tendinitis

Physiotherapy for supraspinatus tendinitis is essential because it targets the root cause of the inflammation and pain in the shoulder tendon. Here’s why it is beneficial:

1. Pain Relief: Physiotherapy includes techniques like manual therapy, ice therapy, and ultrasound treatment, which help reduce pain and inflammation without relying heavily on medication.
2. Improved Mobility: Supraspinatus tendinitis often limits shoulder movement due to stiffness. Physiotherapy helps improve the range of motion through gentle stretching and mobility exercises.
3. Strengthening: Targeted exercises strengthen the rotator cuff muscles, reducing stress on the supraspinatus tendon and preventing further injuries. Stronger muscles around the shoulder enhance overall stability.
4. Injury Prevention: Physiotherapists teach proper posture and movement techniques to avoid strain on the tendon, which helps prevent re-injury during daily activities or sports.
5. Customized Treatment: Physiotherapy offers a tailored approach to healing, focusing on the individual’s condition, lifestyle, and activity level, ensuring an optimal recovery process.

main risk factors of supraspinatus tendinitis?

The main risk factors for supraspinatus tendinitis include engaging in repetitive overhead activities such as those found in sports (e.g., tennis, swimming) or jobs that involve heavy lifting. Poor posture, particularly slouching, can reduce the subacromial space and increase the risk. Genetic predisposition, previous shoulder injuries, and the natural aging process, which can narrow the subacromial space, also contribute to the condition. Additionally, primary and secondary shoulder impingement due to structural abnormalities or weakened rotator cuff muscles are significant risk factors.

Content is medically reviewed by:

Shruti Bangera, Masters In Neurological Physiotherapy, Senior Physiotherapist & SME, Portea

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faq’s 

1. How is Supraspinatus tendinitis diagnosed?

 Supraspinatus tendinitis is diagnosed through a detailed process that includes taking the patient’s medical history, performing a physical examination, and utilizing imaging studies. The physical exam often involves checking for tenderness, pain during specific shoulder movements, and assessing range of motion. Imaging techniques such as ultrasound or MRI are used to visualize the tendon and identify inflammation, tears, or other abnormalities. These diagnostic tools help confirm the presence of tendinitis and determine its severity.

2. Can a supraspinatus tendon tear be prevented?

While it is challenging to prevent a supraspinatus tendon tear entirely, certain measures can significantly reduce the risk. Proper technique during sports and physical activities, strengthening shoulder muscles through targeted exercises, and avoiding excessive strain can help. Maintaining good posture and incorporating regular stretching and strengthening routines can also contribute to shoulder health. For those at higher risk, such as athletes or individuals with a history of shoulder issues, preventive strategies and early intervention are crucial.

3. How is a supraspinatus tendon tear treated?

Treatment for a supraspinatus tendon tear typically begins with conservative methods. Resting the shoulder and applying ice can help reduce inflammation and pain. Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and swelling. Physical therapy is often recommended to improve shoulder function, strengthen surrounding muscles, and enhance flexibility. If these conservative treatments are insufficient, corticosteroid injections may be used for more significant pain relief. In cases where these methods fail to provide relief or if there is severe tendon damage, more invasive treatments such as surgery may be considered.

4. Is surgery necessary for Supraspinatus tendinitis?

Surgery for supraspinatus tendinitis is generally considered a last resort and is only recommended when conservative treatments do not provide sufficient relief or if there is significant tendon damage. Most cases of tendinitis can be managed effectively with rest, physical therapy, and medication. Surgery may be necessary if there is a full-thickness tear or severe structural damage that impairs shoulder function and quality of life. The decision for surgery is typically made based on the severity of the condition and the patient’s response to non-surgical treatments.

5. What role does physical therapy play in managing Supraspinatus tendinitis?

Physical therapy plays a crucial role in managing supraspinatus tendinitis by helping to reduce pain, improve shoulder function, strengthen the rotator cuff muscles, and enhance flexibility. Therapists use exercises, manual therapy, and modalities such as heat or ultrasound to promote healing and restore normal shoulder mechanics.