What is the treatment for supraspinatus (suprastinatus) tendonosis?

From the Guidelines

Treatment of supraspinatus tendinosis should begin with conservative measures, including rest, activity modification, and physical therapy focusing on rotator cuff strengthening exercises, as this approach addresses both pain management and the underlying tendon degeneration that characterizes tendinosis. The initial management involves pain relief using NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as well as ice application for 15-20 minutes several times daily to reduce inflammation, and heat therapy before exercises to promote comfort and flexibility 1.

Conservative Management

Conservative management is the cornerstone of treatment for supraspinatus tendinosis. This includes:

• Rest and activity modification to avoid exacerbating the condition
• Physical therapy with a focus on eccentric strengthening exercises for the rotator cuff muscles, particularly the supraspinatus
• Pain management using NSAIDs or other analgesics as needed

Role of Corticosteroid Injections

Corticosteroid injections, such as methylprednisolone 40mg with lidocaine, may be considered if conservative treatment fails after 6-8 weeks, but their use should be limited to 2-3 injections per year due to the potential for tendon weakening 1. The decision to use corticosteroid injections should be made cautiously, considering the potential benefits against the risks of tendon damage.

Surgical Intervention

Surgical intervention is typically reserved for cases that are unresponsive to 6-12 months of conservative management. The decision for surgery should be based on the severity of symptoms, the impact on quality of life, and the presence of any complicating factors such as significant rotator cuff tears or advanced degenerative changes 1.

Recovery and Prevention

Recovery from supraspinatus tendinosis involves a gradual return to activities, maintaining proper posture, and continuing strengthening exercises to prevent recurrence. Supervised exercise programs are beneficial, but in settings where supervision is not feasible, properly trained patients may perform unsupervised home-based exercises 1.

Conclusion is not allowed, so the answer ends here.

From the Research

Treatment Options for Supraspinatus Tendonosis

• Conservative treatment solutions are available for supraspinatus tendinopathy, including physical modalities such as laser, ultrasound, and shock-wave therapy, although evidence for these treatments is limited and contradictory 2
• Exercise, specifically eccentric training, may be beneficial for supraspinatus tendinopathy, but more research is needed to confirm its effectiveness 2
• Manual therapy, including joint and soft tissue mobilization, has been shown to be effective in improving functionality and reducing pain in patients with supraspinatus tendinopathy 3
• A combination of integrative modalities, including osteopathic cross-fiber massage, microcurrent electroacupuncture, far-infrared heat, and photobiomodulation, may be used to relieve chronic pain caused by supraspinatus tendonitis 4
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but evidence for their effectiveness is lacking, and they may not affect gene expression in human tendinopathic tendon 5

Non-Surgical Treatment Modalities

• Eccentric exercise, extracorporeal shock wave therapy, therapeutic ultrasound, hyaluronic acid, platelet-rich plasma, prolotherapy, polydeoxyribonucleotide, and stem cells are among the non-surgical treatment options for tendinopathies 6
• These treatment modalities aim to promote tendon healing, reduce pain and inflammation, and improve functional outcomes 6
• A comprehensive literature review can provide the most updated evidence for caregivers to guide treatment decisions for tendinopathies 6

Rehabilitation and Exercise

• Supervised exercise programs, including eccentric training, can be effective in improving shoulder muscle strength and function in patients with supraspinatus tendinopathy 3
• Home-based rehabilitation programs can also be effective, but may not provide the same level of improvement in functionality as supervised exercise programs with manual therapy 3
• Exercise programs should be tailored to the individual patient's needs and goals, and may involve a combination of strengthening, stretching, and functional exercises 3