From the Guidelines
Grade 1-2 supraspinatus atrophy is associated with worse outcomes and healing after rotator cuff repair, and treatment should focus on addressing the underlying cause of the atrophy and improving muscle quality. The evidence suggests that supraspinatus muscle atrophy correlates with less favorable outcomes after rotator cuff repair 1.
Implications of Grade 1-2 Supraspinatus Atrophy
- The presence of Grade 1-2 supraspinatus atrophy indicates mild to moderate wasting of the supraspinatus muscle, which can negatively impact the ability of a repair to heal and the functional outcome after a repair.
- Preoperative supraspinatus muscle atrophy has been shown to correlate with worse outcomes and healing after rotator cuff repair 1.
- Treatment should focus on physical therapy with specific exercises to strengthen the rotator cuff muscles, including external rotation exercises, scapular stabilization, and progressive resistance training.
- Anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) may help manage pain during the rehabilitation process, but the evidence for their use is inconclusive 1.
Rehabilitation Protocol
- Start with 3 sets of 10-15 repetitions, 3-4 times weekly for at least 6-8 weeks.
- Apply ice for 15-20 minutes after exercises to reduce inflammation.
- Rest from aggravating activities is important, but complete immobilization should be avoided as it can worsen atrophy.
- If symptoms persist after 6-8 weeks of consistent therapy, or if pain is severe, consult with an orthopedic specialist as further imaging or interventions may be necessary.
Underlying Causes
- This condition typically results from rotator cuff tendinopathy, impingement syndrome, or nerve compression affecting the suprascapular nerve.
- Addressing the underlying cause of the atrophy is crucial to improving muscle quality and achieving better outcomes after rotator cuff repair.
From the Research
Implications of Grade 1-2 Supraspinatus Muscle Atrophy
- The implications of Grade 1-2 supraspinatus muscle atrophy are associated with negative prognostic indicators after rotator cuff repair 2
- Supraspinatus muscle atrophy is independently associated with patient age, tendon retraction, and atrophy of the supraspinatus myofibers at the histologic level 2
- Fatty infiltration of the supraspinatus muscle progresses throughout nonoperative treatment, and moderate supraspinatus fatty infiltration appears an average of 3 years after onset of symptoms 3
- Muscular atrophy, measured indirectly using the tangent sign, appears at an average of 4.5 years after the onset of symptoms 3
- Possible denervation of the supraspinatus muscle in rotator cuff injuries may contribute to poor functional outcomes 4
- Nitric oxide-based treatment has potential to promote growth in atrophic supraspinatus muscle after rotator cuff injury and improve functional outcome 4
- Suprascapular neuropathy, which can cause atrophy of the infraspinatus and/or supraspinatus rotator cuff muscles, may be a cause of substantial pain and weakness in patients with and without concomitant shoulder pathology 5
- The occupation ratio of the supraspinatus muscle may change after rotator cuff repair without volumetric improvement, and the muscle volume does not change significantly soon after surgery 6
Diagnostic and Management Considerations
- Magnetic resonance imaging (MRI) is the preferred modality to assess atrophy of the rotator cuff muscles and potential causes of suprascapular nerve compression 5
- Electromyography and nerve conduction velocity studies remain the gold standard for confirmation of the diagnosis of suprascapular neuropathy 5
- Initial management of suprascapular neuropathy is usually nonoperative, consisting of activity modification, physical therapy, and nonsteroidal anti-inflammatory drugs 5
- Surgical intervention is considered for patients with nerve compression by an external source or for symptoms refractory to conservative measures 5