Supraspinatus tendonitis : Guide to treatment

The supraspinatus is usually injured because of heavy repeated demands placed on it ,such as carrying a briefcase, laptop computer, purse, or baby carrier. It is often impinged under the acromiom due to tight pectoralis and tight subscapularis muscles.

The supraspinatus has a small superior shear component, but its main function is compression because
of the horizontal orientation of the muscle fi bers, thus, it opposes the upward superior shear action of the deltoid.

supraspinatus from proximal to distal with forward elevation. The primary point of contact on the bursal side is at  the supraspinatus insertion throughout forward elevation. The subacromialbursa facilitates this motion and contact. It is a unique anatomic arrangement that exposes the soft tissues to wear and degeneration as the arm is elevated and rotated during range of motion of the shoulder. Furthermore, the impingement may be accelerated by any anatomic architectural changes in the acromion or acromioclavicular joint that reduce the volume of the subacromial space.  

The long head of the biceps and tendons of the rotator cuff pass through the subacromial space; these include the supraspinatus, infraspinatus, and teres minor muscles, which insert onto the greater tuberosity of the humerus. The subscapularis muscle inserts onto the lesser tuberosity. The rotator interval is created between the subscapularis and
supraspinatus tendons. All four rotator cuff tendons interlace with each other over the humeral head before inserting. This continuity allows a functional interaction of the rotator cuff.

What should you do ?

The patient will complain of posterosuperior shoulder pain. You do asses the shoulder in the first 20-30˚ of abduction. Movement beyond that is the action of [restrict]the middle deltoid, which will be painful to a resisted test above 30˚ of abduction. Also, the fibers of the supraspinatus tendon can be impinged where it runs under the acromiom process, which can cause chronic pain .

Treatment:

Start with the basic shoulder protocol. Concentrate on scapula muscle balance exercise. You do release the pectoralis major and minor, subclavius, upper trapezius, middle deltoid, and subscapularis. Muscular balance is essential in shoulder rehabilitation.

It is necessary to balance and release all of the muscles perticularly the pectoralis minor and subscapularis, to properly treat this condition. The enhancement between upper trapezius and lower trapezius will help to relieve pain. Most of the time while doing retraction ,patient does elevation with retraction. We should observe the movemtn pattern and break it. Concentrate on serratus activity because it is responsible for upward rotation movement.

Next follow the specific protocol for the supraspinatus including myofascial release, trigger point work, and Eccentric exercise for tendon load is also helpful.

Reassess and repeat the protocol until the client is pain-free.

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