Is the treatment for supraspinatus tendinitis the same as for rotator cuff pain?

Treatment for Supraspinatus Tendinitis

The treatment for supraspinatus tendinitis is essentially the same as for general rotator cuff pain, with initial management focusing on exercise therapy and NSAIDs as first-line treatments. 1, 2

Initial Conservative Management

First-Line Treatments

• Exercise therapy

  • Supervised physical therapy is more effective than unsupervised home exercise 2
  • Should include eccentric strengthening exercises 3
  • Multiple studies show significant improvements in pain and function with structured exercise programs 1
  • Exercise programs should focus on:
    • Rotator cuff strengthening
    • Scapular stabilization
    • Range of motion exercises

• NSAIDs

  • Recommended at maximum tolerated dosage for 2-4 weeks 2
  • Effective for pain management in rotator cuff-related symptoms 1

Second-Line Treatments

• Activity modification

  • Reduce activities that cause repetitive loading of the supraspinatus
  • Avoid complete immobilization to prevent muscle atrophy 2

• Orthotics and braces

  • May help reinforce and protect tendons during activity
  • Limited evidence for effectiveness, but generally safe 1

Physical Modalities (Limited Evidence)

The following treatments have inconclusive or conflicting evidence:

• Corticosteroid injections

  • Conflicting evidence for effectiveness 1
  • Caution: May weaken tendon tissue and predispose to rupture 1
  • Multiple injections may compromise rotator cuff integrity 2

• Other modalities with inconclusive evidence:

  • Pulsed electromagnetic field therapy (PEMF) 1
  • Therapeutic ultrasound 1
  • Extracorporeal shock wave therapy (ESWT) 1
  • Iontophoresis and phonophoresis 1
  • Ice/heat application 1, 2
  • TENS 1

Diagnostic Considerations

• Physical examination

  • Hawkins' test (92% sensitive, 25% specific) 1
  • Neer's test (88% sensitive, 33% specific) 1
  • Assessment for point tenderness and range of motion limitations 2

• Imaging

  • Plain radiographs as first-line imaging 2
  • MRI if symptoms persist beyond 4 weeks 2

Surgical Management

Consider surgical options only after failure of conservative management for at least 6 months 2:

• Arthroscopic removal of calcific deposits if present 4
• Débridement or repair for high-grade partial-thickness tears 2

Common Pitfalls to Avoid

1. Overreliance on corticosteroid injections

   • May inhibit healing and reduce tendon tensile strength 1
   • Can predispose to spontaneous rupture 1

2. Immediate surgical intervention

   • Conservative management should be tried for at least 6 months before considering surgery 2

3. Inadequate exercise program

   • Supervised physical therapy shows better outcomes than unsupervised home exercises 2
   • Exercise programs should be structured and progressive

4. Failure to address biomechanical issues

   • Improper functioning and muscle weakness can permit humeral head migration, resulting in continued impingement 1

In summary, the treatment approach for supraspinatus tendinitis mirrors that of general rotator cuff pain, with exercise therapy and NSAIDs forming the cornerstone of initial management, followed by consideration of other modalities and eventual surgical options if conservative measures fail.