What is the diagnosis and treatment for tendinosis of the supraspinatus (supraspinatus tendon) muscle?

From the Guidelines

Tendinosis of the supraspinatus is a degenerative condition that should be treated with conservative measures, including rest, activity modification, and over-the-counter pain medications, as the initial approach to reduce morbidity and improve quality of life. The treatment plan should prioritize reducing repetitive loading of the damaged tendon to prevent further damage and promote healing and pain relief, as suggested by 1.

Diagnosis

The diagnosis of tendinosis of the supraspinatus can be supported by imaging studies such as MRI, which is sensitive and specific for detecting cuff tears, degeneration, chronic tendinopathy, and partial tears, as indicated by 1. Ultrasonography can also be useful for detecting moderate to full thickness tears and showing tendon changes of chronic tendinopathy.

Treatment Approach

The treatment approach should include:

• Relative rest and reduced activity to prevent further damage and promote healing and pain relief, as recommended by 1.
• Cryotherapy, such as applying ice for 15-20 minutes several times daily, to reduce pain, especially after activity, as suggested by 1.
• Eccentric strengthening exercises, which are an effective treatment for tendinopathy and may reverse degenerative changes, as indicated by 1.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief, as recommended by 1.
• Topical NSAIDs, which are effective and may have fewer systemic side effects, as suggested by 1.
• Consideration of corticosteroid injections for persistent pain, though limited to 2-3 injections per year, as indicated by 1.
• Surgical intervention for more severe cases that have failed conservative therapy, as suggested by 1.

Recovery and Prevention

Recovery from tendinosis of the supraspinatus typically takes 3-6 months with proper treatment, and maintaining good shoulder mechanics through regular exercise helps prevent recurrence. It is essential to individualize treatment according to the patient's signs and symptoms, disease characteristics, and psychosocial factors, as emphasized by 1, although this study is not directly related to tendinosis, the principle of personalized management is crucial in all conditions, including tendinosis of the supraspinatus.

Key Recommendations

• Rest and activity modification are crucial in the initial management to reduce morbidity and improve quality of life.
• Physical therapy, focusing on gentle stretching and strengthening exercises, is essential for promoting healing and preventing further injury.
• Pain management should be tailored to the individual, considering the use of NSAIDs, topical NSAIDs, and corticosteroid injections when necessary.
• Surgical intervention should be considered for cases that do not respond to conservative management, as it can be an effective option for reducing pain and improving function, as indicated by 1.

From the Research

Diagnosis of Supraspinatus Tendinosis

• Supraspinatus tendinosis (ST) refers to the intratendinous degeneration of the supraspinatus tendon 2
• Diagnosis is typically made through a combination of clinical evaluation and imaging studies, such as ultrasound or magnetic resonance imaging (MRI) 2, 3
• Clinical evaluation may include assessment of pain, function, and range of motion, using scales such as the Visual Analogue Scale (VAS), Constant Score, and Disabilities of the Arm, Shoulder and Hand Score (DASH) 2

Treatment Options for Supraspinatus Tendinosis

• Platelet-rich plasma (PRP) injection is a conservative treatment option for supraspinatus tendinosis, which has shown promising results in reducing pain and improving function 2, 4, 5, 6
• PRP injection has been compared to other treatment options, such as extracorporeal shockwave therapy (ESWT) 2, physiotherapy 4, and corticosteroid injections 5, with varying results
• Exercise, such as eccentric training, may also be beneficial in the treatment of supraspinatus tendinosis, although more research is needed 3
• Prolotherapy is another treatment option that has been studied, with results showing improved shoulder function and pain reduction 6

Efficacy of Treatment Options

• PRP injection has been shown to be non-inferior to ESWT in terms of efficacy and safety 2
• PRP injection has also been shown to be more effective than corticosteroid injections in providing pain relief and improving function at 1-year follow-up 5
• The efficacy of PRP injection compared to physiotherapy is less clear, with some studies showing short-term benefits, but longer-term effects are less well understood 4
• Prolotherapy has been shown to be effective in improving shoulder function and pain reduction, although more research is needed to fully understand its effects 6