Supraspinatus tendonitis, also called painful arc syndrome, is an inflammation of the supraspinatus muscle that is found in the shoulder region. The ‘rotator cuff’ muscles are four small muscles found in the shoulder joint. These muscles aid in the movement and stability of the shoulder, though their tendons hold the head of the humerus in position within the joint capsule. One of these tendons – the supraspinatus, impinges on the bone that forms the tip of the shoulder (acromion) as it passes between the head of the humerus and the acromion. The supraspinatus muscles are helpful in the abduction of the arm, which is moving it away from the side of your body up to your head. Found between the supraspinatus tendon and the acromion is a fluid-filled sac known as subacromial bursa which reduces friction between the two structures.

When this sub acromial bursa becomes inflamed, (a condition known as subacromial bursitis), there tend to be friction. This results to wear and tear of the supraspinatus tendons and a subsequent supraspinatus tendonitis. This condition is usually seen among people of age 25-60 and it is the most common inflammatory condition that occurs in the shoulder. 5% of cases involve both shoulders.

Symptoms of supraspinatus tendonitis

Shoulder pain that is severe enough to prevent shoulder movement. Shoulder pain that could be bilateral and result in a subsequent neck pain. Stiffness of the shoulder joint which is often more severe in the early hours of the day. Weakness or not being able to move the joint Feeling a grating or cracking sensation on moving the joint especially during examination of the shoulder Redness, heat and swelling around the joint which are signs of inflammation. Causes/risk factors for supraspinatus tendonitis

Occupation: sportsmen and women or people that do a lot of overhead work are more at risk of wear and tear of the supraspinatus tendon.

Congenital: persons with abnormal shape of the acromion or abnormally tight subacromial space caused by a thickened ligament may be more at risk of developing supraspinatus tendinitis.

Old age: older individuals are prone to having supraspinatus tendonitis. This factor results from gradual degeneration with wear and tear, inflammatory conditions like rheumatoid arthritis, and a fall on the shoulder at old age.

Trauma: fall on the shoulder can expose somebody to developing this condition.

Inflammatory diseases: disorders like rheumatoid arthritis increase one’s vulnerability to supraspinatus tendinitis.

Diagnosis of supraspinatus tendonitis

History of the symptoms (pain), e.g. when first noticed, how frequent is the pain, the nature of the pain, what worsens or relieves it, are all taken.

Physical examination also is crucial. Physical examination is done to rule out direct trauma to the shoulder.

X-ray of the shoulder is carried out to confirm calcification of the tendons or deformity in the anatomy of the acromion.

Prognosis of supraspinatus tendinitis

Up to 70% of the people diagnosed with supraspinatus tendonitis will experience relief and may even mobilize the joint themselves within 1-3weeks of physiotherapy and steroid injection treatment. Surgical interventions are needed for people who have complete tears of the tendons while a long-standing injury and impingement in the long term may result in osteoarthritis.

Treatment of supraspinatus tendinitis

Rest is emphasized at the early stage of the condition. This resolves the inflammation. Analgesics like non-steroidal anti-inflammatory drugs e.g. Naprosyn will help with the inflammation. Corticosteroid injection directly into the supraspinatus tendon or the subacromial bursa under local anaesthesia contributes to reducing pain. Calcification of the tendon may require a surgical removal of the calcium crystals or injection of steroid into the joint for pain management. Arthroscopic acromioplasty: This is a surgical procedure done to reshape the acromion or divide the coracoacromial ligament. This is achieved with the aid of a tiny camera inserted into the shoulder joint through a small surgical opening under anaesthesia. This prevents further episodes. Rotator cuff tendons repair: this is a surgical procedure to repair the rotator tendons.

Other therapies include:
Cryotherapy
Electrical stimulation
Acupuncture
Massage
Range of Motion Exercises
Patient's teaching

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References

Supraspinatus Tendonitis: Background, Epidemiology ... (n.d.). Retrieved from http://emedicine.medscape.com/article/93095-overview Supraspinatus Tendonitis Treatment & Management: Acute Phase ... (n.d.). Retrieved from http://emedicine.medscape.com/article/93095-treatment Supraspinatus Tendonitis Causes and Treatments - EnkiVillage. (n.d.). Retrieved from http://www.enkivillage.com/supraspinatus-tendonitis.html Supraspinatus tendonitis - Physiopedia, universal access to ... (n.d.). Retrieved from http://www.physio-pedia.com/Supraspinatus_tendonitis