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Above and below the horizontal, the space is larger. Right shoulder seen from the front. Space with arm by your side. Acromion. Supraspinatus tendon. Supraspinatus tendonitis is an inflammation of supraspinatus tendon often associated with shoulder impingement syndrome. The im-. Print Friendly, PDF & Email. What is Supraspinatus tendinitis (painful arc syndrome); Statistics on Supraspinatus tendinitis (painful arc.

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Supraspinatus Tendinitis Pdf

Supraspinatus tendinopathy is a common and disabling condition that becomes conditioning program. The effectiveness of manual therapy in supraspinatus tendinopathy. Article (PDF Available) in acta orthopaedica et traumatologica turcica 45(3) · May. to differentiate the supraspinatus from the other rotator cuff tendons and how best to approach its treatment. The Nature of Injury in Supraspinatus Tendinitis.

Close-up view of the calcified lesion [30] Yet diagnosis is usually clinical, but imaging can be useful. Shoulder x-rays can reveal calcifications in rotator cuff tendons and in the bursa [31]. In acute calcific tendinopathy, calcifications may be irregular, fluffy and ill-defined. Dynamic ultrasound can demonstrate thickening of the subacromial bursa and impingement during abduction. Also sonografy and Magnetic resonance imaging MRI can be done [32]. Supraspinatus tendinopathy can be graded using a modified 4-point scale from 0 to 3 based on previous studies [32] [33] [24] [34].

Murell , Microarray analysis of the tendinopathic rat supraspinatus tendon: glutamate signalling and its potential role in tendon degeneration, J. Clinical anatomy — Applied anatomy for students and junior doctors twelfth edition. Oxford: Wiley-Blackwell. Arthroscopic anatomy of the subdeltoid space. Orthopedic Reviews, volume 5:e25, Arthroscopy, A systematic review of the histological and molecular changes in rotator cuff disease.

BJR, vol. B, Johan M. J Musculoskelet. Painful shoulder syndromes: diagnosis and management, clinical reviews.

In: Nimni M. Vol III. Calcific tendonitis of the supraspinatus tendon in a 7-year old boy: diagnostic challenges. Hong Kong Medical Journal, 17, Diagnostic imaging orthopaedics. Impingement syndrome in the athletic shoulder.

Clinical Journal of Sports Medicine, 2, — Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging. American Journal of Roentgenololy,, — Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial.

BMC Musculoskeletal Disorders. The effectiveness of manual therapy in supraspinatus tendinopathy. Ultrasonography of the shoulder. Radiologic Clinics of North America, 30, — R,, Craig, E. V, Feinberg, S. The hyperextended internal rotation view in rotator cuff ultrasonography. Journal of Clinical Ultrasound, 15, — Rotator cuff tears: diagnostic performance of MR imaging. Radiology, , — MR imaging of the shoulder: appearance of the supraspinatus tendon in asymptomatic volunteers.

American Journal of Roentgenology,,— MR imaging of the shoulder: diagnosis of rotator cuff tears. Supraspinatus tendinopathy is a common and disabling condition that becomes more prevalent after middle age [1] [2] and is a common cause of pain in the shoulder [3] [4]. A predisposing factor is resistive overuse [5].


The supraspinatus tendon of the rotator cuff is involved and affected tendons [6] [7] [8] of the musculoskeletal system and becomes degenerated, most often as a result of repetitive stresses and overloading during sports or occupational activities [9]. The tendon of the supraspinatus commonly impinges under the acromion as it passes between the acromion and the humeral head. This mechanism is multifactorial see below. The supraspinatus muscle is of the greatest practical importance in the rotator cuff [10] , derives its innervation from the suprascapular nerve [11] and stabilises the schoulder, exorotates and helps abduct lift up sideways the arm, by initiating the abduction of the humerus on the scapula [10].

Any friction between the tendon and the acromion is normally reduced by the subacromial bursa. The anterior margin of the supraspinatus is defined by the posterior edge of the rotator interval that separates the supraspinatus from the rolled superior border of the subscapularis.

The posterior margin of the supraspinatus is marked by the extension of the raphe between supraspinatus and infraspinatus around the scapular spine. The anterior portion of the supraspinatus is composed of a long and thick tendinous component whereas the posterior portion has been shown to be short and thin [11]. An anatomic dissection study of the supraspinatus footprint found that the mean anterior to posterior dimension of the supraspinatus tendon was 25 mm, with a mean medial to lateral thickness of the footprint of 12 mm - the mean distance from the cartilage to the supraspinatus footprint was 1.

The supraspinatus and infraspinatus tendons fuse 1. The first zone is proper tendon, made up of largely type I collagen and small amounts of decorin. The third zone is mineralised fibrocartilage and consists of type II collagen, with significant amounts of type X collagen and aggrecan. The fourth zone is bone and is largely type I collagen with a high mineral content. This effective bone-tendon attachment is achieved through a functional grading in mineral content and collagen fibre orientation.

The supraspinatus enthesis is a highly specialised in homogeneous structure that is subjected to both tensile and compressive forces [13]. The mean age of onset of this complication is in the sixth decade age 50 to 59 , and it is more frequent in diabetic patients [5]. It is also a common cause of shoulder pain in athletes whose sports involve throwing and overhead motions [6]. The causes of supraspinatus tendinopathy can be primary impingement, which is a result of increased subacromial loading, and secondary impingement, which is a result of rotator cuff overload and muscle imbalance [17].

The table below gives a view on the different extrinsic and intrinsic factors. Patients present with progressive subdeltoid aching that is aggravated by abduction, elevation, or sustained overhead activity.

They feel also tenderness and a burning sensation in their shoulder. The pain may radiate to the lateral upper arm or may be located in the top and front of the shoulder.

It typically becomes worse with overhead activity. Initially, the pain is felt during activities only, but eventually may occur at rest. The shoulder may be warm and there may be fullness anterolaterally.

So supraspinatus tendinopathy is usually consistent with anterior instability causing posterior tightness.

The problems that patient with Supraspinatus Tendinopathy complain off, are pain, inflammation, decreased ROM, strength, and functional activity [5]. In general, the causes of an acute painful shoulder can be classified into different categories, according to the prevailing pathoanatomy. These include [20] [21].

Supraspinatus tendinitis (painful arc syndrome)

More probing investigations can narrow down the differential diagnoses, which could include: The MRI findings of rotator cuff tendinopathy are characterised by thickened inhomogeneous rotator cuff tendon with increased signal intensity on all pulse sequences [22].

Fluid intensity filling an incomplete gap in the tendon on fat suppressed T2-weighted sequences changes are seen on MRI for partial-thickness tears [23]. On MRI, an area of high signal intensity on all pulse sequences outlines complete disruption of the tendon [24].

Diagnosis is usually clinical, but imaging can be useful.

Shoulder x-rays can reveal calcifications in rotator cuff tendons and in the bursa [25] [26]. In acute calcific tendinopathy, calcifications may be irregular, fluffy and ill-defined.

Dynamic ultrasound can demonstrate thickening of the subacromial bursa and impingement during abduction. Magnetic resonance imaging MRI , rather than computed tomography CT , is the preferred modality, since it produces more detailed soft-tissue images [19].

Supraspinatus tendinitis (painful arc syndrome)

Assessing health needs in primary care. Morbidity study from general practice provides another source of information.

BrMed J. Subacromial impingement syndrome. Orthop Rev. Shoulder disorders in general practice: incidence, patient characteristics, and management.

Ann Rheum Dis. Shoulder pain in a community-based rheumatology clinic. Br J Rheumatol. Internal impingement in tennis player: rehabilitation guidelines.

Br J Sports Med. Posterior shoulder tightness and rotator cuff strength assessment in painful shoulders of amateur tennis players. Braz J Phys Ther. Risk of shoulder tendinitis in relation to shoulder loads in monotonous repetitive work. Am J Ind Med. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender.


J Bone Joint Surg Br. Intratendinous strain fields of the intact supraspinatus tendon: the effect of glenohumeral joint position and tendon region. J Orthop Res. Strengthening the supraspinatus: a clinical and biomechanical review.

Clin Orthop Relat Res. Shin KM. Partial-thickness rotator cuff tears. Korean J Pain. Physical therapy and rehabilitation after rotator cuff repair: a review of current concepts. Int J Phys Med Rehabil. The insertional footprint of the rotator cuff: an anatomic study.

Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am.

A systematic review of the histological and molecular changes in rotator cuff disease. Bone Joint Res. Proteoglycans of the human rotator cuff tendons.

Anterior and posterior musculotendinous anatomy of the supraspinatus.

Tensile properties of a morphologically split supraspinatus tendon.