From the Guidelines
Supraspinatus tendinosis should be treated with conservative measures, including rest, ice application, and physical therapy, as the primary approach to manage symptoms and improve quality of life, as evidenced by the most recent and highest quality studies 1.
Key Recommendations for Treatment
- Rest from aggravating activities to prevent further damage and promote healing
- Ice application for 15-20 minutes several times daily to reduce pain and inflammation
- Over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) for pain relief
- Physical therapy, focusing on gentle stretching and progressive strengthening exercises for the rotator cuff muscles, typically 2-3 sessions weekly for 6-8 weeks
- Proper posture and ergonomic adjustments during daily activities to reduce strain on the shoulder
Diagnostic Imaging
- MRI can aid in detecting osseous and soft tissue abnormalities, including tendinosis and partial-thickness tears, as noted in the study by 1
- Ultrasonography and plain radiography may also be useful in diagnosing tendinopathy, but MRI is the most sensitive and specific imaging modality
Treatment Outcomes
- Most cases of supraspinatus tendinosis improve within 3-6 months with consistent conservative therapy
- Surgery is rarely needed unless conservative treatment fails after 6-12 months or if there's significant functional limitation
- Corticosteroid injections may provide temporary relief for persistent pain, but should be limited to 2-3 injections per year
Pathophysiology
- Supraspinatus tendinosis results from repetitive microtrauma, aging, or poor blood supply to the tendon, causing collagen disorganization and tissue weakening, as described in the study by 1
From the Research
Supraspinatus Tendonosis Treatment Options
- The treatment of supraspinatus tendonosis can involve various methods, including platelet-rich plasma (PRP) injections, corticosteroid injections, exercise, and physical modalities such as laser, ultrasound, and shock-wave therapy 2, 3.
- A study comparing PRP injections and corticosteroid injections for partial supraspinatus tears found that both treatments resulted in similar pain relief and functional improvement at 1 month, but PRP injections showed superior benefits at 6 months 2.
- Exercise, particularly eccentric training, may be beneficial for supraspinatus tendinopathy, but more research is needed to confirm its effectiveness 3.
- Manual therapy, including joint and soft tissue mobilization, can be effective in reducing pain and improving function in patients with supraspinatus tendinopathy 4.
Conservative Management Protocols
- A conservative management protocol for calcific tendinitis of the supraspinatus tendon involving phonophoresis, cross-friction massage, and range of motion exercises has been shown to be effective in resolving symptoms and eliminating calcific deposits 5.
- A combination of integrative modalities, including osteopathic cross-fiber massage, microcurrent electroacupuncture, far-infrared heat, and photobiomodulation, may be used to relieve chronic pain caused by supraspinatus tendonitis 6.
- Supervised exercise programs, with or without manual therapy, can be effective in reducing pain and improving function in patients with supraspinatus tendinopathy 4.
Treatment Efficacy and Complications
- The efficacy of different treatment options for supraspinatus tendonosis can vary, and more research is needed to determine the most effective treatments 2, 3, 4.
- Complications from treatment, such as corticosteroid injections, can be a concern, and alternative treatments like PRP injections may be considered 2.
- The use of integrative modalities, such as those described in 6, may offer a promising approach for relieving chronic pain caused by supraspinatus tendonitis, but more research is needed to validate this approach.