From the Guidelines
The initial treatment for supraspinatus tendinosis should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. This approach is based on the understanding that most patients with overuse tendinopathies, including supraspinatus tendinosis, fully recover within three to six months with conservative management 1. The treatment plan should include:
- Relative rest to avoid exacerbating the condition
- Icing to reduce pain and inflammation
- Eccentric strengthening exercises to promote tendon healing and strengthen the surrounding muscles
- Activity modification to avoid aggravating the shoulder, particularly overhead movements
- Pain management with topical or systemic nonsteroidal anti-inflammatory drugs (NSAIDs) for acute pain relief, although their use should be cautious and limited 1. It is essential to note that injected corticosteroids can relieve pain but should be used with caution, and surgery should be reserved for patients who have failed conservative therapy 1. By prioritizing conservative management and avoiding unnecessary interventions, patients with supraspinatus tendinosis can expect to achieve significant improvement in their symptoms and quality of life within a few months.
From the Research
Initial Treatment for Supraspinatus Tendinosis
The initial treatment for supraspinatus tendinosis typically involves conservative approaches. Some of the treatment options include:
- Exercise, such as eccentric training, which may have beneficial effects 2
- Trigger point dry needling or corticosteroid injections, which are commonly used treatments 3, 4
- Physical modalities like laser, ultrasound, and shock-wave therapy, although evidence for these is limited and contradictory 2
- Platelet-rich plasma (PRP) injection, which has shown promise in some studies, particularly for partial supraspinatus tears 5
- Hypertonic dextrose prolotherapy, which may provide short-term relief from pain, disability, and improved shoulder range of motion 6
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for supraspinatus tendinosis, including:
- Percutaneous electrolysis (PE) versus trigger point dry needling (TDN), with PE showing greater improvement in pain and function 3
- Glucose prolotherapy versus corticosteroid injection, with no significant difference between the two at 3-month follow-up 4
- PRP injection versus corticosteroid injection, with PRP showing superior benefits at 6-month follow-up 5
- Hypertonic dextrose injection versus placebo, with significant improvement in pain, disability, and shoulder range of motion at 2-week follow-up 6
Considerations for Treatment
When considering treatment options for supraspinatus tendinosis, it is essential to: