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:This blog is a quick overview on the causes and treatment of supraspinatus tendonitis:
This is an issue I see every week in the office. The supraspinatus muscle is located deep on top of the shoulder and responsible for moving the arm away from the side position (abduction). Although it is a small muscle it is an important muscle for the stability of the shoulder and works together with a group of muscles known as the rotator cuff.
Most commonly people are affected after middle age [1] and is also frequently caused by overuse and especially resisted overuse such as overhead exercises like the bench press and pull downs. Sometimes more than one muscle is involved and painful which I often see the biceps tendon tender and dysfunctional. People who have very physical jobs like cleaners, builders and nurses from experience have had shoulder issues often involving this supraspinatus muscle due to performing the same action over and over again for long periods of time. We talk about the muscle but most commonly it is the tendon that is the pain generator. A tendon is a fibrous and very hardy tissue that runs off of the end of a muscle and connects to a bony landmark, in this case the outer edge of the humerus (upper arm bone). As we get older the bones can morph and change in structure, sometimes the acromion (a bone that lies above the supraspinatus tendon/muscle) can develop and bone spur which rubs against the tendon causing irritation, inflammation and eventually pain. There are also pouches between tendons called bursa which can be mistaken for tendinitis but they can also be inflamed at the same time depending on the cause.
What does it feel like?
We all experience pain differently, many people could show tendinitis through imaging such as ultrasound yet feel no pain at all where as others the pain can be debilitating and life changing.
Pain can be sharp, a dull ache and even a burning sensation [2], and in many cases the pain can travel down on the outside of the arm. Sleeping can be troublesome for many as they report they cannot get comfortable, tossing and turning a lot of the night which then affects mood, which in turn increases pain levels. After a period of time the shoulder can become limited in it's range of motion which can cause muscle imbalance and dysfunction. When we are in pain the body goes into bracing mode to avoid certain movements that causes pain. What this does is create more dysfunction because more muscles are over working to create this bracing effect. Before you know it a chronic condition has started.
Could it be something else?
It could be but in most cases it can be diagnosed with orthopaedic/muscle tests, general movement assessments and a detailed case history. Some treatment is usually performed and if there is no response then further special tests would be requested such as MRI, ultrasound, X-ray and blood tests if warranted. There is an encyclopedia of musculoskeletal conditions but the most common differential diagnosis would be osteoarthritis of the shoulder, bicipital tendinitis, cervical injuries such as disc bulges or trauma and brachial plexus (upper neck nerves) injury.
What can be done?
The first step is to give the patient confidence in their own body again if it is a long standing issue. People often think or get into the mind set that they are broken so part of my job is to show then how strong and robust they actually are. People often work through the pain and think nothing of it but when they get home and try to relax that is often the time they are dwelling on it and pain levels increase, especially at night. If their pain was that severe then they would not be able to have worked that day (some cases do require time off work also). The next step is finding some new ways to move that causes less pain, this takes the edge off as it gives the tendon a well needed rest. Rest is important for over use injuries because often it is the constant repetitive motions that has caused the pain in the first place. Soft tissue work to lengthen the muscle helps relieve tension from the tendon as well as manipulating any joints that could be restricting the supraspinatus muscle. I have found that cervical manipulation has helped many patients feel more free and reduce pain. This is lacking in evidence unfortunately. Ice, NSAID's, massage, changing their mattress, ultrasound therapy, posture advice/correction, acupuncture, sports taping, diet and self management all have their place also. When pain levels and their range of motion have improved then rehab is the next port of call. Movement therapy is there from the beginning building up to weighted exercises to stabilise the shoulder and create normal function and of course in the long term produces less pain.
Prognosis:
A tricky one as there are many ways this issue can happen, the majority of cases will respond to care, some will clear up on their own and others will need more intensive treatment. Either way we can reduce pain levels and increase a persons quality of life!
I hope you enjoyed reading this blog today
Till next time
Yours in health
Matthew Corbin DC
References:
1. 6. Chard M.D., Sattelle L.M., Hazlerman B.L. (1988). The long-term outcome of rotator cuff tendinitis – a review study. Br. J. Rheumatol 1988, 27:385-389.
2. 29. Sommerich C.M., McGlothlin J.D., Marras W.S. (1993), Occupational risk factors associated with soft tissue disorders of the shoulder: a review of recent investigations in the literature, Ergonomics 36:697-717.