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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