Supraspinatus tendinopathy | Common cause of Shoulder Pain

Supraspinatus tendinopathy is a common and crippling condition that becomes more prevalent after middle age. It is a common cause of shoulder pain. The supraspinatus tendon lies in the subacromial space and is a part of the rotator cuff muscles. Overuse of the supraspinatus tendon is attributed to be the principal factor that predisposes to this condition. Supraspinatus tendon of the rotator cuff becomes degenerated most often as a result of repetitive stresses and overloading during sports or occupational activities, paving the way for tendinopathy. The tendon of the supraspinatus commonly impinges under the acromion as it passes between the acromion and the humeral head.

What is supraspinatus tendinopathy?

The supraspinatus muscle is located in the supraspinatus fossa behind the scapula. It is connected to the supraspinatus tendon – a thick fibrous band of tissue that connects the supraspinatus muscle to the shoulder joint. Supraspinatus tendon is a part of the rotator cuff. The function of the supraspinatus is to facilitate movement of the arm upwards. When there is a damage or injury to the supraspinatus tendon, it is referred to as supraspinatus tendinopathy.

The average age of onset of this complication is in one’s 50s due to degeneration during the normal process of aging when all of the tendons of the rotator cuff start to become weak as the muscle becomes weaker. Diabetic patients are more prone to the condition. It is also a common cause of shoulder pain in athletes whose sports involve throwing and overhead motions (tennis or badminton as it involves raising the arms frequently and repetitively above shoulder level). Tendon impingement is the main cause of supraspinatus tendinopathy, which could be due to subacromial loading. Other causes include rotator cuff overload and muscle imbalance.

Causes and Characteristics of supraspinatus tendinopathy:

As stated above, overuse is the principal cause that leads to supraspinatus tendinopathy. People affected with the condition may have progressive subdeltoid aching and it gets worse by abduction, elevation or sustained overhead activity. There may be tenderness and burning sensation around the shoulder as well. Pain is felt in the arm and behind the shoulder while moving the arm upwards like waving at someone. The pain may radiate to the lateral upper arm or may be located in the top and front of the shoulder. Activities over the head typically make the pain worse. In the beginning, pain is felt only during activities, but at the later stages even at rest, pain can be experienced.

It could be an underlying supraspinatus tendinopathy if the patient says:

Pain increases with reaching
Pain is felt after frequent repetitive activity at or above shoulder
Patient feels weakness of resisted abduction and forward flexion, especially with pushing and overhead movements
Patient has difficulty sleeping at night due to pain, especially when lying on the affected shoulder and with an inability to sleep
Patient has difficulties with simple movements, such as brushing hair, putting on a shirt or jacket or reaching the arm above shoulder height
Patient has a limited range of motion in the shoulder
Patient had a former shoulder trauma

The shoulder may be warm to touch and there may be fullness anterolaterally. Furthermore, arc of motion can generate pain between 70° and 120° of abduction. Anterior instability leading to posterior tightness is generally associated with supraspinatus tendinopathy. The patient may complain pain, inflammation, decreased range of motion, strength and functional activity.

Treatment for the supraspinatus tendinopathy:

Conservative approach is the first-line of treatment for the condition by avoiding activities that may aggravate the condition and applying heat and cold, and doing stretching exercises. Treatment begins with measures to relieve pain and inflammation by prescribing pain medications and NSAIDs. This will bring down the pain and inflammation. The next mode of treatment is to strengthen the muscles and tendons that form a part of the supraspinatus. The person affected with the condition cannot move the arm as easily as s/he used to be because of the weakness of the tendons. In order to overcome this, the physiotherapist will formulate strengthening exercises. Exercises that increase the range of the shoulder will also be designed by the physiotherapist as the motion of the shoulder is affected severely by this condition. Therapeutic exercises are found to be effective for remodeling and strengthening degenerated tendons in the supraspinatus. Bracing is another form of passive modality treatment for supraspinatus tendinopathy

Once the strength starts to return and the arm can be moved without much difficulty, gradual return to activities of daily living is recommended. As for the complete recovery and healing of the condition, it may take anywhere between a couple of weeks to four weeks, till then complete return to normal activities is not advised. However, if your are a person who takes part in sports or your job involves vigorous overhead activities, it may take further two weeks.

It should be understood that tendinopathies are a highly prevalent problem in musculoskeletal speciality of medicine and the doctor will prescribe the correct treatment modality after thorough physical examination and medical tests, if necessary.

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Q&As on Supraspinatus Tendinopathy

1) What should I avoid with supraspinatus tendinopathy?

When you have a supraspinatus tear, you should avoid all kinds of extreme range motion involving your shoulders. Exercises include behind the neck, pressing of the shoulder, upright rows, and all other activities that need to use your upper arms behind the torso. While trying to do exercises using your injured shoulder, ensure you are keeping your range of motion restricted to what is comfortable.

2) How can I prevent supraspinatus tendinopathy?

Primary prevention must be considered an essential part of treating supraspinatus tendinosis. Educating patients about the risks involved can do a lot in circumventing supraspinatus tendinopathy development. Those athletes involved in throwing and other kinds of overhead sports, along with the laborers doing repetitive shoulder pressure, must be given instructions on good warm-up techniques, specified methods of shoulder strengthening, and a proper understanding of all warning signs of early tendinosis.

3) What are the different stages of Supraspinatus tendinosis?

Supraspinatus tendinosis mainly occurs when the rotator cuff tendon becomes mechanically impinge beyond the anteroinferior part of the acromion, especially when the shoulder is kept in the forward flexed and internally rotating position.

There are three stages of supraspinatus tendinopathy:

Stage 1

It mainly affects patients younger than 25 and is characterized by acute inflammation, bleeding in the rotator cuff, and edema. It is easy to reverse this stage through some non-operative treatment.

Stage 2

It affects patients in the age group 25 – 40, which mainly results from the scale of stage 1. Here the rotator cuff tendon advances to fibrosis and tendonitis, which usually do not respond to any traditional treatment and needs operative involvement.

Stage 3

It mainly affects patients who are over 40 years. When this condition starts progressing, it might lead to mechanical disturbances of the rotator cuff tendon and alterations in the coracoacromial arch with osteoporosis in the anterior acromion. Here, you must repair the surgical anterior acromioplasty arch and the rotator cuff.

4) What are the different symptoms of supraspinatus tendinosis?

Supraspinatus tendinosis mainly causes local soreness and sensitivity on the front side of the shoulder. You might feel pain and stiffness while lifting your arm. You might also feel pain while lowering your arm from the elevated position. Starting symptoms can be mild. Therefore, patients usually do not look for treatment during the initial period. Some of the symptoms might include:

Minor pain is present both while doing activities and also during rest.
Pain radiates from the front of the shoulder towards the side of your arm.
Sudden pain while lifting and movements
Athletes of overhead sports might feel pain while throwing the ball. When the problem enhances, symptoms start increasing, such as
Pain when you sleep at night
Loss of motion as well as strength
Facing problems while carrying out activities that require you to place your arm behind your back, like zippering or fastening.
If your pain arises suddenly, your shoulder might become tender. All movements become painful as well as limited.

5) How long does it take to heal supraspinatus tendinopathy?

The minimal time required to recover from supraspinatus tendinopathy is two to four weeks, and some stubborn cases take several months. During the early stages, you should aim to decrease swelling and inflammation.