Supraspinatus Tendonitis - Clinicals, Diagnosis, and Management

Rheumatology

Clinicals - History

Fact Explanation
Shoulder pain. Inflammation of the supraspinatus tendon Shoulder pain.
Inflammation of the supraspinatus tendon
Onset of pain possibly in relation to specific injury or it may be a pain of gradual onset Injury to the muscle-fibers and tendon due to an acute insult or due to overuse, leading to inflammation Onset of pain possibly in relation to specific injury or it may be a pain of gradual onset
Injury to the muscle-fibers and tendon due to an acute insult or due to overuse, leading to inflammation
Pain is located on the anterolateral aspect of the shoulder The anterolateral portion of the tendon is the part that is initially affected Pain is located on the anterolateral aspect of the shoulder
The anterolateral portion of the tendon is the part that is initially affected
Pain worsens on flexion and abduction Impingement of the swollen tendon on the anteroinferior part of the Acromion Pain worsens on flexion and abduction
Impingement of the swollen tendon on the anteroinferior part of the Acromion

Clinicals - Examination

Fact Explanation
Swelling and erythema of the affected shoulder Due to the inflamed tendon Swelling and erythema of the affected shoulder
Due to the inflamed tendon
Asymmetry will be noted on the affected side when comparing both shoulders The inflamed tendon leading to swelling of the affected shoulder Asymmetry will be noted on the affected side when comparing both shoulders
The inflamed tendon leading to swelling of the affected shoulder
Well-localized tenderness on palpation over the supraspinatus muscle Pressure over the inflamed tendon leads to pain Well-localized tenderness on palpation over the supraspinatus muscle
Pressure over the inflamed tendon leads to pain
Active movements- limited abduction and flexion. Active abduction and flexion are limited because of worsening of the pain Active movements- limited abduction and flexion.
Active abduction and flexion are limited because of worsening of the pain
Active movements- the pain is at its worst during the middle of the range of abduction (60-120 degrees i.e. the painful arc) and then reduces as the arm is fully raised The supraspinatus muscle supports the deltoid in abduction along this arc. Active movements- the pain is at its worst during the middle of the range of abduction (60-120 degrees i.e. the painful arc) and then reduces as the arm is fully raised
The supraspinatus muscle supports the deltoid in abduction along this arc.
Passive movements- not restricted The articulation itself is usually not compromised. Passive movements- not restricted
The articulation itself is usually not compromised.
"Full can test" to assess the supraspinatus muscle- abduction of the shoulders to 90 degrees in forward flexion with the thumbs pointing upwards and the elbows fully extended. The patient then attempts to elevate the arms against the examiner's resistance. There will be pain and weakness on the affected side. The inflamed tendon leads to pain and the pain will lead to inhibition of the action of the muscle "Full can test" to assess the supraspinatus muscle- abduction of the shoulders to 90 degrees in forward flexion with the thumbs pointing upwards and the elbows fully extended. The patient then attempts to elevate the arms against the examiner's resistance. There will be pain and weakness on the affected side.
The inflamed tendon leads to pain and the pain will lead to inhibition of the action of the muscle
Neer's test- place the arm in forced flexion with the arm fully pronated. Pain with this maneuver indicates a positive test Sub-acromial impingement of the inflamed supraspinatus tendon Neer's test- place the arm in forced flexion with the arm fully pronated. Pain with this maneuver indicates a positive test
Sub-acromial impingement of the inflamed supraspinatus tendon
Hawkins' test- elevate the patient's arm to 90 degrees while forcibly internally rotating the shoulder. Pain with this maneuver indicates a positive test Sub-acromial impingement of the inflamed supraspinatus tendon Hawkins' test- elevate the patient's arm to 90 degrees while forcibly internally rotating the shoulder. Pain with this maneuver indicates a positive test
Sub-acromial impingement of the inflamed supraspinatus tendon

Investigations - Diagnosis

Fact Explanation
Plain radiograph- Antero-posterior(AP) view of the shoulder (with the arm at 30-degrees external rotation) To assess the gleno-humeral joint, subacromial osteophytes and sclerosis of the greater tuberosity Plain radiograph- Antero-posterior(AP) view of the shoulder (with the arm at 30-degrees external rotation)
To assess the gleno-humeral joint, subacromial osteophytes and sclerosis of the greater tuberosity
Plain radiograph- Outlet Y-view of the shoulder To assess the subacromial space and to differentiate between the different anatomic variations of the acromion process Plain radiograph- Outlet Y-view of the shoulder
To assess the subacromial space and to differentiate between the different anatomic variations of the acromion process
Plain radiograph- Axillary view of the shoulder To visualize the acromion and coracoid process. Also, in order to visualize coracoacromial ligament calcifications Plain radiograph- Axillary view of the shoulder
To visualize the acromion and coracoid process. Also, in order to visualize coracoacromial ligament calcifications
Ultrasonography of the shoulder Shows characteristic changes of tendinosis. Also useful if a rotators cuff tear is suspected Ultrasonography of the shoulder
Shows characteristic changes of tendinosis. Also useful if a rotators cuff tear is suspected
Magnetic resonance imaging(MRI) of the shoulder Best imaging modality for rotators cuff pathology. Shows characteristic changes of tendinosis Magnetic resonance imaging(MRI) of the shoulder
Best imaging modality for rotators cuff pathology. Shows characteristic changes of tendinosis

Management - Supportive

Fact Explanation
Relative rest of the shoulder with avoidance of aggravating activities (Avoid complete immobilization) Relative rest reduces pain, prevents further damage and may promote tendon healing Relative rest of the shoulder with avoidance of aggravating activities (Avoid complete immobilization)
Relative rest reduces pain, prevents further damage and may promote tendon healing
Application of ice on the affected shoulder Effective for short-term pain relief. Application of ice may blunt the inflammatory response and thus reduce the pain and swelling Application of ice on the affected shoulder
Effective for short-term pain relief. Application of ice may blunt the inflammatory response and thus reduce the pain and swelling
Physiotherapy (Strengthening and stretching exercises- once the pain has subsided) Prevents joint stiffness and promotes the formation of new collagen Physiotherapy (Strengthening and stretching exercises- once the pain has subsided)
Prevents joint stiffness and promotes the formation of new collagen
Technique modification In order to minimize the repetitive stresses placed on tendons in order to reduce pain and promote healing Technique modification
In order to minimize the repetitive stresses placed on tendons in order to reduce pain and promote healing
Sub-acromial injection of local anesthetic (e.g. lidocaine) Temporary improvement of symptoms Sub-acromial injection of local anesthetic (e.g. lidocaine)
Temporary improvement of symptoms

Management - Specific

Fact Explanation
Nonsteroidal anti-inflammatory drugs(NSAIDs)- oral and topical Anti-inflammatory and analgesic properties Nonsteroidal anti-inflammatory drugs(NSAIDs)- oral and topical
Anti-inflammatory and analgesic properties
Corticosteroid injections- once a surgically repairable tendon tear is excluded (steroids can be combined with local anesthetics) Anti-inflammatory and analgesic properties Corticosteroid injections- once a surgically repairable tendon tear is excluded (steroids can be combined with local anesthetics)
Anti-inflammatory and analgesic properties
Therapeutic ultrasonography Reduces pain and increases the rate of collagen synthesis Therapeutic ultrasonography
Reduces pain and increases the rate of collagen synthesis
Extracorporeal shock wave therapy (ESWT) Induces structural and neurochemical alterations in order to reduce pain and promote tendon healing Extracorporeal shock wave therapy (ESWT)
Induces structural and neurochemical alterations in order to reduce pain and promote tendon healing
Iontophoresis and phonophoresis Delivers topical NSAIDs and corticosteroids to symptomatic subcutaneous tissues (by using electronic and ultrasonographic impulses) Iontophoresis and phonophoresis
Delivers topical NSAIDs and corticosteroids to symptomatic subcutaneous tissues (by using electronic and ultrasonographic impulses)

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