From the Guidelines
Supraspinatus tendinopathy is best treated with a combination of rest, physical therapy, and anti-inflammatory medications, with the goal of reducing morbidity, mortality, and improving quality of life. Initially, reduce activities that cause pain and apply ice for 15-20 minutes several times daily to reduce inflammation, as recommended by 1. Take non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks to manage pain and inflammation, as suggested by 1 and 1.
Treatment Approach
Begin a structured physical therapy program focusing on gentle stretching and progressive strengthening of the rotator cuff muscles, typically 2-3 sessions weekly for 6-8 weeks. Incorporate exercises such as:
- Pendulum stretches
- Wall crawls
- Eventually resistance band external rotation exercises
If symptoms persist after 4-6 weeks of conservative treatment, consider a corticosteroid injection administered by a healthcare provider, as mentioned in 1. This condition occurs when the supraspinatus tendon, which helps lift the arm away from the body, becomes inflamed or damaged from repetitive overhead activities, poor posture, or age-related degeneration.
Recovery and Outcomes
Recovery typically takes 3-6 months with proper treatment and adherence to rehabilitation protocols. It is essential to prioritize the patient's quality of life and minimize morbidity and mortality by providing effective treatment and management of supraspinatus tendinopathy, as emphasized by 1. Surgery may be considered in carefully selected patients who have failed conservative therapy, as noted in 1.
Key Considerations
- Relative rest and reduced activity prevent further damage and promote healing and pain relief, as recommended by 1.
- Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes, as suggested by 1.
- Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes, as mentioned in 1.
From the Research
Supraspinatus Tendinopathy Treatment Options
- Various treatment modalities are available for supraspinatus tendinopathy, including physiotherapy, analgesics, corticosteroid injection, surgical repair, and platelet-rich plasma (PRP) injection 2.
- A study comparing PRP injection with physiotherapy found that PRP group had better pain relief and functional improvement at 1 and 4 weeks, but the results were insignificant at 12 weeks 2.
- Another study found that supervised exercise, supervised and manual therapy, and home-based exercise are all effective methods in the rehabilitation of patients with subacromial impingement syndrome, with the addition of manual therapy improving the results of rehabilitation with exercise 3.
Effectiveness of Platelet-Rich Plasma (PRP) Injections
- A randomized clinical trial comparing PRP injections with corticosteroids found that PRP injections resulted in significant improvement in pain and range of motion, and may be a better option for patients with rotator cuff tendinopathy 4.
- However, a systematic review of systematic reviews found that the evidence for PRP injections in treating tendinopathy is inconclusive, and that eccentric exercises are the most consistently effective treatment for tendinopathy 5.
Other Treatment Options
- Eccentric exercises have been shown to be an effective treatment for tendinopathy, with moderate evidence supporting the use of low-level laser therapy and extracorporeal shockwave therapy 5.
- Corticosteroids have been found to be effective for short-term pain relief, but are deemed ineffective and potentially contraindicated for long-term use 5.
- Minimally invasive surgical procedures have been found to be more effective than open surgical interventions for treating tendinopathy 5.
Pathophysiology and Assessment
- Supraspinatus tendinopathy is thought to be caused by both intrinsic and extrinsic factors, with structural and biological changes occurring when tendinopathy develops 6.
- Assessment is paramount in order to differentiate the structure involved and offer a proper treatment solution, with knowledge of the general concepts regarding the development of supraspinatus tendinopathy and the healing process guiding physiotherapists in proposing treatment options 6.