What are the implications of supraspinatus and infraspinatus tendinosis?

From the Guidelines

Supraspinatus and infraspinatus tendinosis should be treated with conservative measures, including rest, ice, and anti-inflammatory medications, as the initial approach, given that most patients fully recover within three to six months 1.

Treatment Approach

The treatment of supraspinatus and infraspinatus tendinosis should prioritize conservative management to alleviate symptoms and promote recovery. This approach is supported by the fact that about 80 percent of patients with overuse tendinopathies fully recover within three to six months 1. Conservative measures include:

• Rest from aggravating activities to reduce further strain on the affected tendons
• Ice application for 15-20 minutes several times daily to help reduce pain and inflammation
• Anti-inflammatory medications, such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily with food), for 1-2 weeks to manage pain and inflammation

Physical Therapy and Pain Management

Physical therapy plays a crucial role in the treatment of supraspinatus and infraspinatus tendinosis. It should focus on:

• Gentle stretching exercises to improve flexibility and reduce stiffness
• Progressive strengthening exercises to enhance muscle strength and support the affected tendons, typically 2-3 sessions weekly for 6-8 weeks Proper form and technique are essential during physical therapy to avoid further irritation of the tendons. For pain management, acetaminophen (up to 1000mg every 6 hours, not exceeding 4000mg daily) can be considered as an alternative or adjunct to anti-inflammatory medications.

Considerations for Advanced Cases

If symptoms persist after 4-6 weeks of conservative treatment, corticosteroid injections may provide temporary relief. However, the use of corticosteroid injections should be approached with caution, as their long-term effects on tendon healing are not well understood 1. Severe cases that are unresponsive to conservative management for 3-6 months may require surgical intervention. The decision for surgery should be made on a case-by-case basis, considering factors such as the severity of symptoms, the impact on quality of life, and the presence of any underlying conditions that may affect surgical outcomes.

Prevention and Lifestyle Modifications

Preventing recurrence of supraspinatus and infraspinatus tendinosis involves making lifestyle modifications, including:

• Maintaining proper posture and ergonomics during daily activities to reduce strain on the shoulder tendons
• Avoiding repetitive overhead activities or taking regular breaks to stretch and rest the shoulders
• Engaging in regular exercise to strengthen the shoulder muscles and improve overall flexibility and mobility.

From the Research

Supraspinatus and Infraspinatus Tendinosis

• Supraspinatus tendinopathy is a frequent cause of shoulder pain, and its pathophysiology is not fully understood 2.
• The condition is thought to be caused by both intrinsic and extrinsic factors, leading to structural and biological changes in the tendon 2.
• Assessment is crucial to differentiate the structure involved and offer a proper treatment solution, with knowledge of the general concepts regarding the development of supraspinatus tendinopathy guiding treatment options 2.
• Exercise in the form of eccentric training may be beneficial for supraspinatus tendinopathy, but more research is needed 2.
• Manual therapy, including joint and soft tissue mobilization, can be effective in treating supraspinatus tendinopathy, with significant improvements in pain, muscle strength, and function 3.

Diagnostic Techniques

• Diagnostic musculoskeletal ultrasound (MSK-US) is a valuable tool for assessing the infraspinatus muscle and tendon, offering real-time, dynamic assessment capabilities essential for precise diagnosis and effective rehabilitation planning 4.
• MSK-US can accurately identify common pathologies such as tears, tendinopathy, and calcifications in the infraspinatus muscle and tendon 4.
• The technique specifics, diagnostic accuracy, and comparative efficacy of MSK-US against other imaging modalities make it an excellent alternative imaging modality for diagnosing rotator cuff tears 4.

Treatment Options

• Supervised exercise programs, supervised exercise programs combined with joint and soft tissue mobilization, and home-based rehabilitation programs can be effective in treating supraspinatus tendinopathy 3.
• The addition of initial manual therapy may improve the results of rehabilitation with exercise 3.
• Eccentric training may be considered as a treatment option for supraspinatus tendinopathy, but more research is needed to confirm its effectiveness 2.