From the Guidelines
Management for a patient with a positive empty can test indicating potential supraspinatus tendinopathy typically follows a stepwise approach beginning with conservative measures. Initial management includes relative rest from aggravating activities, ice application for 15-20 minutes several times daily to reduce inflammation, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 1-2 weeks to manage pain and inflammation, as suggested by 1. Physical therapy is crucial and should focus on rotator cuff strengthening exercises, scapular stabilization, and proper shoulder mechanics, typically 2-3 sessions weekly for 6-8 weeks. For persistent symptoms, a subacromial corticosteroid injection (such as 40mg methylprednisolone with 4-5ml of lidocaine 1%) may be considered, though limited to 2-3 injections annually to prevent tendon weakening, as noted in 1. Activity modification techniques should be taught to avoid overhead movements that exacerbate symptoms. This conservative approach is effective because supraspinatus tendinopathy often results from repetitive microtrauma and overuse, leading to inflammation and degeneration of the tendon, as explained in 1. If conservative management fails after 3-6 months, imaging such as MRI may be warranted to assess for tears, and surgical options including arthroscopic debridement or repair might be considered for refractory cases or complete tears, as recommended by 1 and 1.
Some key points to consider in the management of supraspinatus tendinopathy include:
- The importance of early diagnosis and treatment to prevent further injury and promote healing, as discussed in 1 and 1.
- The use of imaging studies, such as MRI, to confirm the diagnosis and assess the extent of the injury, as noted in 1 and 1.
- The role of physical therapy in promoting recovery and preventing future injury, as suggested by 1 and 1.
- The potential benefits and risks of corticosteroid injections and surgical intervention, as discussed in 1 and 1.
Overall, a comprehensive approach to management that incorporates these considerations can help to optimize outcomes and improve quality of life for patients with supraspinatus tendinopathy, as supported by the evidence from 1, 1, 1, 1, and 1.
From the Research
Management of Supraspinatus Tendinopathy
The management of a patient with a positive empty can test indicating potential supraspinatus tendinopathy involves a comprehensive approach.
- Assessment is crucial to differentiate the structure involved and offer a proper treatment solution 2.
- Exercise in the form of eccentric training may be considered as it seems to have beneficial effects, however, more research is needed 2.
- Physical modalities such as laser, ultrasound, and shock-wave therapy have little and contradictory evidence 2.
- Supervised exercise, supervised and manual therapy, and home-based exercise are all effective and promising methods in the rehabilitation of patients with subacromial impingement syndrome 3.
- The addition of an initial manual therapy may improve the results of the rehabilitation with exercise 3.
Diagnostic Accuracy of the Empty Can Test
The empty can test does not selectively activate the supraspinatus muscle, and its diagnostic accuracy is questionable 4, 5.
- The test may have poor diagnostic accuracy, bringing into question the validity of these tests 4.
- Other shoulder muscles, such as the infraspinatus and the middle head of the deltoid, are also activated during the test 5.
- The Whipple test, empty-can test, and full-can test have been compared, and the results show that the Whipple test has a high risk of false-positive results 6.
Treatment Options
Treatment options for supraspinatus tendinopathy include: