Supraspinatus Tear: Difference between revisions

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== Definition/Description ==
[[File:Supraspinatus muscle - Kenhub.png|alt=Supraspinatus muscle (highlighted in green) - posterior view|right|frameless|500x500px|Supraspinatus muscle (highlighted in green) - posterior view]]
A supraspinatus tear is a tear or rupture of the tendon of the [[supraspinatus]] muscle. The supraspinatus is part of the [[Rotator Cuff|rotator cuff]] of the shoulder. Most of the time, it is accompanied by another [[Rotator Cuff Tears|rotator cuff muscle tear]]. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear.<ref name=":0">American Academy of Orthopedic Surgeons, Ortho Info. Rotator cuff tears, http://orthoinfo.aaos.org/topic.cfm?topic=a00064 (accessed 29/08/2018).</ref> Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity.<ref name=":6">Benazzo F, Marullo M, Pietrobono L. [https://link.springer.com/article/10.1007/s10195-013-0271-x Supraspinatus rupture at the musculotendinous junction in a young woman.] Journal of Orthopaedics and Traumatology 2014;15(3):231-4.</ref>


== Definition/Description ==
Image: Supraspinatus muscle (highlighted in green) - posterior view<ref >Supraspinatus muscle (highlighted in green) - posterior view image -  © Kenhub https://www.kenhub.com/en/library/anatomy/supraspinatus-muscle</ref>  
A supraspinatus tear is a tear or rupture of the tendon of the [[supraspinatus]] muscle. The supraspinatus is part of the [[Rotator Cuff|rotator cuff]] of the shoulder. Most of the time it is accompanied with another [[Rotator Cuff Tears|rotator cuff muscle tear]]. This can occur in due to a trauma or repeated micro-trauma and present as a partial or full thickness tear.<ref name=":0">American Academy of Orthopedic Surgeons, Ortho Info. Rotator cuff tears, http://orthoinfo.aaos.org/topic.cfm?topic=a00064 (accessed 29/08/2018).</ref> Most of the time the tear occurs in the tendon or as an avulsion from the greater tuberosity<ref>Benazzo F, Marullo M, Pietrobono L. [https://link.springer.com/article/10.1007/s10195-013-0271-x Supraspinatus rupture at the musculotendinous junction in a young woman.] Journal of Orthopaedics and Traumatology 2014;15(3):231-4.</ref>.


== Clinical relevant anatom ==
== Clinical Relevant Anatomy ==
[[File:Supraspinatus.png|right|250x250px]]
The [[Shoulder|shoulder joint]] is made up of three bones: the [[humerus]], [[scapula]] and clavicle. The head of the humerus and the glenoid of the scapula form a ball-and-socket joint<ref name=":0" />. The supraspinatus muscle is located on the back of the shoulder, forming part of the [[Rotator Cuff|rotator cuff]]. The rotator cuff consists of [[Supraspinatus|Supraspinatus,]] [[Infraspinatus]], [[Subscapularis]] and [[Teres Minor|teres minor]]. The rotator cuff covers the head of the humerus and keeps it in place. These muscles help to lift and rotate the arm. Visit the [[shoulder]] for more detailed information.
The [[Shoulder|shoulder joint]] is made up of three bones: the [[humerus]], [[scapula]] and clavicle. The head of humerus and glenoid of the scapula form a ball-and-socket joint<ref name=":0" />. The supraspinatus muscle is located on the back of the shoulder, forming part of the [[Rotator Cuff|rotator cuff]]. The rotator cuff consists of [[Supraspinatus|Supraspinatus,]] [[Infraspinatus]], [[Subscapularis]] and [[Teres Minor|teres minor]]. The rotator cuff covers the head of the humerus and keeps it into place. These muscles help to lift and rotate the arm. Also see the page for the [[shoulder]] for more detailed information.
[[File:Muscles of the scapular region anterior aspect Primal.png|thumb]]


=== Supraspinatus ===
=== Supraspinatus ===
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* '''Insertion''':  Greater tubercle of the humerus
* '''Insertion''':  Greater tubercle of the humerus
* '''Innervation''':  Supraspinatus nerve (C5-C6)
* '''Innervation''':  Supraspinatus nerve (C5-C6)
* '''Function''':  Abduction of the glenohumeral joint; assists the rotator cuff in stabilizing, control and movement the shoulder; assists in preventing sublaxation at the shoulder
* '''Function''':  Abduction of the glenohumeral joint; assists the rotator cuff in stabilizing, control and movement the shoulder; assists in preventing subluxation at the shoulder
<ref name=":0" /><ref>Schünke M, Schulte E, Schumacher U, Voll M, Wesker K. Prometheus: Algemene anatomie en bewegingsapparaat, 2010. p600.</ref><ref>Physioworks, Rotator Cuff Tear.http://physioworks.com.au/injuries-conditions-1/rotator-cuff-tears (accessed 29/08/2018).</ref> <u></u>
<ref name=":0" /><ref>Schünke M, Schulte E, Schumacher U, Voll M, Wesker K. Prometheus: Algemene anatomie en bewegingsapparaat, 2010. p600.</ref><ref>Physioworks, Rotator Cuff Tear.http://physioworks.com.au/injuries-conditions-1/rotator-cuff-tears (accessed 29/08/2018).</ref> <u></u>
== Epidemiology/Etiology ==
== Epidemiology/Aetiology ==
The etiology of supraspinatus tears is multifactorial, consisting of age-related degeneration, microtrauma and macrotrauma. The incidence increases with the age to about 50% during the 80s, mostly affecting the dominant arm.<ref name=":10">Tashjian RZ. [https://www.sportsmed.theclinics.com/article/S0278-5919(12)00044-0/abstract Epidemiology, natural history and indications for treatment of rotator cuff tears]. Clinics in Sports Medicine 2012:31(4):589-604.</ref><ref name=":11">Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. [https://www.sciencedirect.com/science/article/pii/S1058274609002043 Prevalence and risk factors of a rotator cuff tear in the general population.] Journal of shoulder and elbow surgery 2010:19(1):116-20.</ref> <sup></sup><sup></sup>Injury and degeneration are the two main causes of rotator cuff tears. Rotator cuff tears are associated with older patients, a history of trauma and mostly affect the dominant arm. The most common risk factors for a tear consist of a history of trauma, dominant arm and age.
The aetiology of supraspinatus tears is multifactorial, consisting of age-related degeneration, microtrauma, and macrotrauma. It mostly affects the dominant arm with about 50% of people in their 80s experiencing this condition. <ref name=":10">Tashjian RZ. [https://www.sportsmed.theclinics.com/article/S0278-5919(12)00044-0/abstract Epidemiology, natural history and indications for treatment of rotator cuff tears]. Clinics in Sports Medicine 2012:31(4):589-604.</ref><ref name=":11">Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. [https://www.sciencedirect.com/science/article/pii/S1058274609002043 Prevalence and risk factors of a rotator cuff tear in the general population.] Journal of shoulder and elbow surgery 2010:19(1):116-20.</ref> Injury and degeneration are the two main causes of rotator cuff tears. Rotator cuff tears are associated with older patients, those with a history of trauma and mostly affect the dominant arm.  
 
=== Mechanism of injury ===
* Acute tear:  Can occur with other shoulder injuries (e.g. clavicle fracture of [[Shoulder Dislocation|shoulder dislocation]])
** Fall on your outstretched arm 
** Heavy lifting something too heavy


* Degenerative:  Wear and tear of the tendon slowly over time  
=== Mechanism of Injury ===
** Increases with the age  
Acute tear:  Can occur with other shoulder injuries (e.g. clavicle fracture of [[Shoulder Dislocation|shoulder dislocation]])
** More common in the dominant arm   
* Fall on an outstretched arm
** When you have a degenerative tear in one shoulder, you have a greater risk for a tear in the opposite shoulder, even if you have no pain in the opposite shoulder.  
* Lifting something too heavy
 
=== Risk factors ===
Degenerative:  Wear and tear of the tendon slowly over time  
* Increases with the age  
* More common in the dominant arm   
* When you have a degenerative tear in one shoulder, you have a greater risk for a tear in the opposite shoulder, even if you have no pain in the opposite shoulder.  
=== Risk Factors ===
* > 40 years old
* > 40 years old
* Male > Female
* Male > Female
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* Lack of blood supply  
* Lack of blood supply  
* Bony spurs  
* Bony spurs  
* Overhead activities and other people who do overhead work:
* Overhead activities and other people who do overhead work: Tennis players, Baseball pitchers, Painters, Carpenters, and Plumbers.
** Tennis players
* Traumatic injury e.g. fall (more common cause in younger individuals)<ref name=":0" />
** Baseball pitchers
== Characteristics/Clinical presentation ==
** Painters
Supraspinatus tears are normally present as partial or full-thickness tears. It can be asymptomatic or symptomatic. 
** Carpenters
** Plumbers
* Traumatic injury e.g. fall (more common cause in younger individuals)
<ref name=":0" />


== Characteristics/Clinical presentation ==
'''Partial thickness''':   
Supraspinatus tears normally present as partial or full-thickness tears. The can be asymptomatic or symptomatic. 
* Incomplete disruption of muscle fibres<ref name=":0" />
* '''Partial thickness''':  Incomplete disruption of muscle fibers<ref name=":0" />
* Can progress to complete tear - Increasing pain is normally the first sign of the progression of a tear
** Can progress to complete tear - Increasing pain is normally the first sign of progression of a tear
'''Full thickness''':  Complete disruption of muscle fibres  
* '''Full thickness''':  Complete disruption of muscle ibers  
* Large tears (1-1,5cm) have a high rate of progression   
** Large tears (1-1,5cm) have high rate of progression   
* If progression is suspected in conservatively managed cases - further investigation is warranted   
** If progression is suspected in conservatively managed cases - further investigation is warranted   
* Smaller tears (<1cm) progress slower   
** Smaller tears (<1cm) progress slower   
<ref name=":10" /><ref name=":11" />   
<ref name=":10" /><ref name=":11" />   


=== Signs & symptoms ===
=== Signs and Symptoms ===
Patients normally present with:<ref name=":0" /><ref name=":11" /><ref>Mayo Clini Rotator cuff injury. http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/dxc-20126923 (accessed 30/08/2018).</ref>
Patients normally present with:<ref name=":0" /><ref name=":11" /><ref name=":13">Mayo Clinic Rotator cuff injury. http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/dxc-20126923 (accessed 30/08/2018).</ref>
* Pain/worsening pain (in cases where tears are progressing): Most common symptom
 
** Pain when lifting and lowering your arm or with specific movemen
* Pain/worsening pain (in cases where tears are progressing), the most common symptoms are:
** Pain at rest  
 
** Pain at night, predominantly when you lie on the affected shoulder  
:* Pain when lifting and lowering your arm or with specific movement
** Traumatic tears: Sudden, intense pain often accompanied by a snapping sensation and immediate weakness in the upper arm  
:* Pain at rest
** Located anterolaterally and superiorly  
:* Pain at night, predominantly when you lie on the affected shoulder
** Referred to the level of the [[deltoid]] insertion with full-thickness tears  
:* Traumatic tears: Sudden, intense pain often accompanied by a snapping sensation and immediate weakness in the upper arm
** Repetitive strain tear:  Starts off mild and only when lifting your arm; over time the pain can become more noticeable at rest  
:* Located anterolaterally and superiorly
** Aggravated in overhead or forward-flexed position  
:* Referred to the level of the [[deltoid]] insertion with full-thickness tears
:* Repetitive strain tear:  Starts off mild and only when lifting your arm; over time the pain can become more noticeable at rest
:* Aggravated in overhead or forward-flexed position
 
* Limited range of motion
 
:* Reduced forward elevation, external rotation and abduction
:* Struggle with activities like reaching behind back, combing hair and overhead activities
:* Stiffness


* Limited range of motion:
* Weakness when rotating or lifting your arm
** Reduced forward elevation, external rotation and abduction
** Struggle with activities like reaching behind back, combing hair and overhead activities
* Weakness when rotating or lifting your arm  
* Crepitus
* Clicking
* Stiffness
* Limited range of motion:
** Reduced forward elevation, external rotation and abduction
** Struggle with activities like reaching behind back, combing hair and overhead activities
* Instability


=== Differential diagnosis ===
* Crepitus, Clicking, and Instability
 
=== Differential Diagnosis ===
* [https://www.physio-pedia.com/Acromioclavicular_Joint_Disorders Acromioclavicular joint injury]  
* [https://www.physio-pedia.com/Acromioclavicular_Joint_Disorders Acromioclavicular joint injury]  
* [https://www.physio-pedia.com/Brachial_plexus_injury Brachial plexus injury]
* [https://www.physio-pedia.com/Brachial_plexus_injury Brachial plexus injury]
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* [[Internal Impingement of the Shoulder|Shoulder impingement syndrome]]
* [[Internal Impingement of the Shoulder|Shoulder impingement syndrome]]
* [[SLAP Lesion|Superior labrum lesions]]
* [[SLAP Lesion|Superior labrum lesions]]
* [[Shoulder subluxation|Shoulder subluxation]]  
* [[Shoulder Subluxation|Shoulder subluxation]]  
* Angina pectoris
* Angina pectoris
* [[Myocardial Infarction|Myocardial infarction]]
* [[Myocardial Infarction|Myocardial infarction]]
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<ref name=":1">Medscape. Supraspinatus tendonitis: Differential diagnoses, http://emedicine.medscape.com/article/93095-differential (Accessed 20/03/2015).</ref><ref name=":2">Medscape. Rotator cuff injury: Differential diagnoses, http://emedicine.medscape.com/article/92814-differential, (Accessed 25/03/2015).</ref>
<ref name=":1">Medscape. Supraspinatus tendonitis: Differential diagnoses, http://emedicine.medscape.com/article/93095-differential (Accessed 20/03/2015).</ref><ref name=":2">Medscape. Rotator cuff injury: Differential diagnoses, http://emedicine.medscape.com/article/92814-differential, (Accessed 25/03/2015).</ref>


== Diagnostic procedures ==
== Diagnostic Procedures ==
=== Physical examination ===
=== Physical Examination ===
* Subjective interview:
** Onset: Spontaneous or after injury
** Duration of pain
** Pain provocation/aggravating factors
** Night rest
** Same problems in the past?
** Activity limitations
** Localize pain
** Past medical history
** Recreational or sport activities (possible overhead activities)


* Observation:
==== Subjective interview: ====
* Onset: Spontaneous or after injury
* Duration of pain
* Pain provocation/aggravating factors
* Night rest
* Same problems in the past?
* Activity limitations
* Localize pain
* Past medical history
* Recreational or sport activities (possible overhead activities)
 
==== Observation: ====
** Any atrophy present
** Any atrophy present
* Range of motion:
 
** Expect reductions in flexion, abduction and external rotation
==== Range of motion: ====
** If passive abduction range is more than active range, it is an indication of a rotator cuff tear
* Expect reductions in flexion, abduction and external rotation
* Muscle power:
* If passive abduction range is more than active range, it is an indication of a rotator cuff tear
** Test supraspinatus by resisting abduction at 90° and internal rotation
 
** Scapular movement may be affected
==== Muscle power: ====
* Palpation:  Forearm behind back to palpate rotator cuff just anterior and below the acromion
* Test supraspinatus by resisting abduction at 90° and internal rotation
* Scapular movement may be affected
 
==== Palpation:  ====
* Forearm behind back to palpate rotator cuff just anterior and below the acromion
** Muscle atrophy present
** Muscle atrophy present
** Tenderness
** Tenderness


* Special tests:
==== Special tests: ====
** Drop-arm test:  Active shoulder abduction to 90°, then return <ref name=":4">Hughers PC, Taylor NF, Green RA. [https://ac.els-cdn.com/S0004951408700229/1-s2.0-S0004951408700229-main.pdf?_tid=8b887d9e-8135-4347-a25d-3c50c63efd54&acdnat=1535600075_4f552aaa403df67a5cac32ef4184113d Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review.] Aust J Physiother 2008;54(3):159-70.</ref>
* Drop-arm test:  Active shoulder abduction to 90°, then return <ref name=":4">Hughers PC, Taylor NF, Green RA. [https://ac.els-cdn.com/S0004951408700229/1-s2.0-S0004951408700229-main.pdf?_tid=8b887d9e-8135-4347-a25d-3c50c63efd54&acdnat=1535600075_4f552aaa403df67a5cac32ef4184113d Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review.] Aust J Physiother 2008;54(3):159-70.</ref>
*** Positive:  Dropping the arm down with pain indicates a positive test
** Positive:  Dropping the arm down with pain indicates a positive test
{{#ev:youtube|JXgRBeqToik}}
{{#ev:youtube|6AUlMbdzaDE}}
** Jobe/supraspinatus/empty can test:  Resist shoulder abduction and internal rotation<ref name=":4" />
<clinicallyrelevant id="83864746" title="Drop Arm Test" /><br>
*** Positive: Pain/weakness
:* Jobe/supraspinatus/empty can test:  Resist shoulder abduction and internal rotation<ref name=":4" />
{{#ev:youtube|5BjDQ-jcBek}}
:** Positive: Pain/weakness
** Full can test:  Resisted shoulder abduction in external rotation
{{#ev:youtube|nSlrWoCfs4w}}
*** Positive: Pain/weakness
<clinicallyrelevant id="83864751" title="Empty Can Test" />
{{#ev:youtube|NuBOHdm20cc}}
:* Full can test:  Resisted shoulder abduction in external rotation
** Subacromial grind test:  Patient standing and examiner standing facing the patient, the examiner grasps the patient's flexed elbow. The shoulder is passively abducted in the scapular plane to 90°. The examiner's other hand is placed over the patient's shoulder overlying the anterior acromion and greater tuberosity. The examiner passively internally and externally rotates the shoulder detecting the presence of palpable crepitus.  
:** Positive: Pain/weakness
*** Positive: Palpable crepitus.<ref name=":12">Sawalha S, Fischer J. The accuracy of “subacromial grind test” in diagnosis of supraspinatus rotator cuff tears. International journal of shoulder surgery 2015;9(2):43-46.</ref>
{{#ev:youtube|05TCh3VXMOU}}
<clinicallyrelevant id="83864778" title="Full Can Test" />
:* Subacromial grind test:  Patient standing and examiner standing facing the patient, the examiner grasps the patient's flexed elbow. The shoulder is passively abducted in the scapular plane to 90°. The examiner's other hand is placed over the patient's shoulder overlying the anterior acromion and greater tuberosity. The examiner passively internally and externally rotates the shoulder detecting the presence of palpable crepitus.  
:** Positive: Palpable crepitus.<ref name=":12">Sawalha S, Fischer J. The accuracy of “subacromial grind test” in diagnosis of supraspinatus rotator cuff tears. International journal of shoulder surgery 2015;9(2):43-46.</ref>
{{#ev:youtube|f5yOT2hpTac}}
{{#ev:youtube|f5yOT2hpTac}}
<ref>Walters J, editor. Orthopaedics - A guide for practitioners. 4th Edition. Cape Town: University of Cape Town, 2010.</ref><ref name=":5">Orthop J. Rotator cuff tear: physical examination and conservative treatment. Department of Orthopaedic Surgery Tohoku University, 2013:197–204.</ref>
<ref>Walters J, editor. Orthopaedics - A guide for practitioners. 4th Edition. Cape Town: University of Cape Town, 2010.</ref><ref name=":5">Orthop J. Rotator cuff tear: physical examination and conservative treatment. Department of Orthopaedic Surgery Tohoku University, 2013:197–204.</ref>


=== Special investigations ===
=== Special Investigations ===
* '''[[X-Rays|X-rays]]:'''
 
** Exclude sclerosis and osteophyte formation on the acromion
=== X-rays ===
** Measure the size of the subacromial space  
* Excluding sclerosis and osteophyte formation on the acromion
** Unable to see tendon
* [[X-Rays|X-ray]]s measure the size of the subacromial space
* '''[[MRI Scans|MRI]]'''[[MRI Scans|:]] Shows partial or full tears in the tendons of the rotator cuff, inflammation to weak structures and cracks in the capsule
* Unable to see the tendon
* '''[[CT Scans|CT scan]]''':  Able to localize tendon when patient positioned with forearm behind back
[[File:Tear of supraspinatus tendon.png|thumb|Supraspinatus tear as seen in radiographics]]
* '''[[Ultrasound Scans|Ultrasound]]''':  Able to localize tendon
 
==== MRI ====
* [[MRI Scans|MRI]] Scan shows partial or full tears in the tendons of the rotator cuff, inflammation to weak structures and cracks in the capsule


== Outcome measures ==
==== CT Scan ====
* [[SF-36|Short Form-36]] (SF-36)
* [[CT Scans|CT scan]] is able to localize tendon when patient positioned with forearm behind the back
 
==== Ultrasound ====
* '''[[Ultrasound Scans|Ultrasound]] helps in''' localising  tendon
 
== Outcome Measures ==
* [[36-Item Short Form Survey (SF-36)|Short Form-36]] (SF-36)
* Rotator Cuff Quality of Life (RC-QOL) scale
* Rotator Cuff Quality of Life (RC-QOL) scale
* [[Western Ontario Rotator Cuff (WORC) Index|Western Ontario Rotator Cuff (WORC) index]]
* [[Western Ontario Rotator Cuff (WORC) Index|Western Ontario Rotator Cuff (WORC) index]]
* [https://www.physio-pedia.com/DASH_Outcome_Measure Disabilities of the Arm, Shoulder and Hand (DASH)]<ref name=":0" /><sup></sup><u></u><sup></sup>
* [https://www.physio-pedia.com/DASH_Outcome_Measure Disabilities of the Arm, Shoulder and Hand (DASH)]<ref name=":0" /><sup></sup><u></u><sup></sup>
== Medical management ==
== Medical Management ==


=== Conservative management ===
=== Conservative Management ===


Indications:<ref name=":10" /><ref name=":11" />   
Indications:<ref name=":10" /><ref name=":11" />   
* Older (>70 years) patients with chronic tear   
* Older (>70 years) patients with a chronic tear   
* Patients with irreparable tears with irreversible changes   
* Patients with irreparable tears with irreversible changes   
* Patients of any age with small (&lt;1 cm) full-thickness tears   
* Patients of any age with small (&lt;1 cm) full-thickness tears   
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* Patients without a full-thickness tear   
* Patients without a full-thickness tear   


Management include:<ref>Björkenheim JM, Paavolainen P, Ahovuo J, Slätis P. [https://europepmc.org/abstract/med/3180567 Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results.] Clinical orthopaedics and related research 1988;(236):148-53.</ref>
Management includes:<ref>Björkenheim JM, Paavolainen P, Ahovuo J, Slätis P. [https://europepmc.org/abstract/med/3180567 Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results.] Clinical orthopaedics and related research 1988;(236):148-53.</ref>
* NSAID's:
 
** Ibuprofen
NSAID's:
** Corticosteroid injections:
* Ibuprofen
*** Eliminate pain for a period of time, making physiotherapy management easier
Corticosteroid injections:
*** Tendon tissue can be weakened by these injections (which would have an adverse effect on the outcome of a possible surgery)
* Eliminate pain for a period of time, making physiotherapy management easier
*** Limited to 2 injections
* Tendon tissue can be weakened by these injections (which would have an adverse effect on the outcome of a possible surgery)
* Limited to 2 injections


* Physiotherapy (see Physiotherapy management below)
* Physiotherapy (see Physiotherapy management below)


=== Surgical management ===
=== Surgical Management ===
'''Indications''':<ref name=":10" /><ref name=":11" /><ref name=":3" />
'''Indications''':<ref name=":10" /><ref name=":11" /><ref name=":3" />
* Failed conservative management  
* Failed conservative management  
* Larger symptomatic full-thickness tears ( 1-1,5cm) as a result of the high rate of progression
* Larger symptomatic full-thickness tears (1-1,5cm) as a result of the high rate of progression. Should be considered for earlier surgical repair in younger patients if the tear is repairable and the muscle degeneration is limited
** Should be considered for earlier surgical repair in younger patients if the tear is repairable and the muscle degeneration is limited
* Acute large tears (&gt;1 cm-1.5 cm) or  
* Acute large tears (&gt;1 cm-1.5 cm) or  
* Young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes
* Young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes
* Complete tear with significant pain and dysfunction after 6 months of treatment
* Repeated dislocations


'''Surgery''':  Rotator cuff repair<ref name=":3">Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clinical orthopaedics and related research 2009;467(4):966-78.</ref>
==== Rotator cuff repair ====
* Mostly done arthroscopically
Most repairs are done arthroscopically<ref name=":3">Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clinical orthopaedics and related research 2009;467(4):966-78.</ref>. Severity (partial vs full-thickness) will determine the approach.
* Severity (partial vs full-thickness) will determine approach
* Partial repair: The tendon and surrounding bone will be smoothed to avoid further damage and therefore allowing the tendon to heal mostly on its own<ref>American Academy of Orthopedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/ (accessed 30/08/2018).</ref>
* Partial repair:<ref>American Academy of Orthopedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/ (accessed 30/08/2018).</ref>
** The tendon and surrounding bone will be smoothed to avoid further damage and therefor allowing the tendon to heal mostly on its own
* Complete tear:<ref>Akpınar S, Uysal M, Pourbagher MA, Ozalay M, Cesur N, Hersekli MA. [https://europepmc.org/abstract/med/21908964 Prospective evaluation of the functional and anatomical results of arthroscopic repair in small and medium-sized full-thickness tears of the supraspinatus tendon.] Acta orthopaedica et traumatologica turcica 2011;45(4):248-53.</ref>
** Tear in middle of tendon:  Suture the two parts of the tendon back together.
** Tear close or on its point of attachment on the head of the humerus:  Attach the tendon back to its original place by an anchor (sometimes two). This anchor actually consists of a small screw that is bored into the head of the humerus with on the back surgical wires which hold the tendon in place.


== Physiotherapy management ==
* Complete tear: Tear in middle of tendon: Suture the two parts of the tendon back together. Tear close or on its point of attachment on the head of the humerus:  Attach the tendon back to its original place by an anchor (sometimes two). This anchor actually consists of a small screw that is bored into the head of the humerus with on the back surgical wires which hold the tendon in place<ref>Akpınar S, Uysal M, Pourbagher MA, Ozalay M, Cesur N, Hersekli MA. [https://europepmc.org/abstract/med/21908964 Prospective evaluation of the functional and anatomical results of arthroscopic repair in small and medium-sized full-thickness tears of the supraspinatus tendon.] Acta orthopaedica et traumatologica turcica 2011;45(4):248-53.</ref>.


There are more opnions about what is the right management. It depends of how sincere the tear is. Most of the time a combination of surgery and physicacal therapy is recommend.<br>In case of a complete tear of the supraspinatus muscle significant pain and dysfuction after six months of treatment or repeated dislocations surgery will be preferred as treatment. However if it is only a partial tear in most cases a conservative treatment will reduce pain(2-6weeks) and over time even allow the patient to regain function (up to three months).<ref name=":6">Dr. Romanski C., Schuldt J. Conservative Treatment of Rotator Cuff Injuries to Avoid Surgical Repair. (2009). (level of evidence 5)
== Physiotherapy Management  ==
</ref> (LoE 5) The reduced pain is not just the direct effect of the pain reducing abilities of NSAID’s. The long term effects will mostly be attributable to a well preformed physical therapy. This will consist of different parts: reduce pain, manipulate blood flow (control inflammation and speed up healing), increase range of motion, increase control of muscles and their strength. Massage can be used to reduce pain, cryotherapy is useful to reduce pain, but only in the first 48 hours after injury. Corticosteroid injection may be useful to reduce pain as well, but only works on short term. <br>To increase range of motion one can use stretching exercises of the ruptured muscle (not to soon in recovery since premature stretching might aggravate the injury)(see below), passive- and active range of motion exercises such as pendulum exercises and symptom limited active-assisted range of motion exercises(see below). To increase control and strength the patient will also be prescribed strengthening exercises for the rotator cuff specifically the functions of the supraspinatus muscle (abduction and exorotation) explain SS and external rotation<ref name=":5" />(LoE 5) <ref>Tanaka M. et al. Factors related to successful outcome of conservative treatment for rotator cuff tears. (2010) Journal of Medical Sciences, Upsala, 115, 193–200 (level of evidence 1B)</ref> (LoE 1B) (see below for a few examples).<br><br> [[Image:4.png]]<br> Kristian Berg. Prescriptive stretching; Human Kinetics&nbsp;<ref name=":7">Kristian Berg. Prescriptive stretching; Human Kinetics; 2011</ref><br> [[Image:5.png]] 


Kristian Berg. Prescriptive stretching; Human Kinetics <ref name=":7" />
Physiotherapy management depends on the extent of the tear, and plays in important role in both conservative management as well as post-surgical rehabilitation. More details can also be obtained from the [[Rotator Cuff Tears|rotator cuff]] page.


[[Image:7.png|300x300px]][[Image:8.png|300x300px]]  
=== Conservative Management ===
'''Physiotherapy goals''':
* Improve pain together with NSAID’s (2-6 weeks)
* [[Cryotherapy]] (only in first 48 hours)
* [[Massage]]
* Improve circulation (to control inflammation and speed up the healing process)
* Improve range of motion:
** [[Stretching]] (careful with timing, as stretching of acute injury may aggravate the tear):<ref name=":8">Kuhn JE. [http://kinesiologiarcb.com.ar/wp-content/uploads/2016/05/Exercise-in-the-treatment-of-rotator-cuff-impingement-A-systematic-review-and-a-synthesized-evidence-based-rehabilitation-protocol.pdf Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.] Journal of shoulder and elbow surgery 2009;18(1):138-60.
</ref> 
*** Crossover arm stretch: 12 seconds, 5 times a day; 5-6days/week 
[[Image:4.png|400x400px]]


[[Image:9.png|300x300px]][[Image:10.png|300x300px]][[Image:11.png|300x300px]]
''Kristian Berg. Prescriptive stretching; Human Kinetics''&nbsp;<ref name=":7">Kristian Berg, Human Kinetics:. Prescriptive stretching. 2011.</ref>
* Door stretch: 5 x 30 seconds (5 second rest in between)


Dr. Romanski C., Schuldt J. Conservative Treatment of Rotator Cuff Injuries to Avoid Surgical Repair.<ref name=":6" /> (LoE 5)
* Passive/Active range of motion:<ref>Joseph Berman MD. Supraspinatus tear, http://www.josephbermanmd.com/diagnosis-treatament-of-the-shoulder/rotator-cuff-tear/ (accessed 29/04/2015).</ref>
** Pendulum exercises: Forward and back, side-to-side, circular motion. 2 sets of 10 a day, 5-6days/week
** Symptom limited active-assisted range of motion exercises
[[Image:5.png|270x270px]]


<br>Home exercises consisting of stretching and strengthening exercises prove to be effective, no matter what type of injury (partial defects, full thickness tears of the supraspinatus tendon or massive rotator cuff defects). Patients with rotator cuff defects do benefit from simple home exercises independent from the size of the defect. There is an improvement in range of motion and a downward trend for impingement<ref>Heers G. et al. Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect. (2005) Klinik für Orthopädie der Universität Regensburg, Bad Abbach. (level of evidence 2B)
''Kristian Berg. Prescriptive stretching; Human Kinetics <ref name=":7" />''
</ref>(LoE 2B) <br>
* Increase strength:<ref name=":9">Physioroom. Exercises to Strengthen the Rotator Cuff Muscles in the Shoulder.http://www.physioroom.com/experts/asktheexperts/answers/qa_mb_20050225.php (accessed 31/08/2018).</ref><ref>Heers G, Anders S, Werther M, Lerch K, Hedtmann A, Grifka J. [https://europepmc.org/abstract/med/15776325 Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect.] Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin 2005;19(1):22-7.
</ref>
** Rotator cuff (especially supraspinatus) strengthening to improve muscle control and strength
** Prone Horizontal Abduction progress by using resistance bands
** Prone Row with External Rotation


<br>
* Regain function of affected upper limb (up to 3 months)
 
* Home exercise programme
=== Stretching ===
* Pendulum exercise: lean forward and place one hand on a counter or table for support. The other arm hang freely. Gently swing your arm forward and back. Repeat the exercise moving the arm side-to-side, repeat again in a circular motion. Do not round the back or lock the knees. 2 sets of 10 a day, 5-6days/week.<ref>Dr. Joseph Berman MD, Tag: Supraspinatus tear, http://www.josephbermanmd.com/diagnosis-treatament-of-the-shoulder/rotator-cuff-tear/ (accessed on April 29 2015) (level of evidence 5)</ref> (LoE 5)
* Crossover arm stretch: relax the shoulder and gently pull one arm across your chest as far as possible (adduction of the upper arm) During the stretching of 12 seconds the shoulder is held in active depression. Do not pull or put pressure on you elbow. You move the arm until you feel the stretch the most, this position (around the horizontal position) is held for 12 seconds, 5 times a day; 5-6days/week.<ref name=":8">Kuhn JE, Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Sug. 2009 Jan-Feb; 18(1):138-60. (level of evidence 1A)
</ref> (LoE 1A) Performed in a corner or door jamb. Each stretch should be held for 30 seconds and repeat 5 times, with 10 second rest between each stretch.<ref name=":8" /> (LoE 1A) <br>
'''<u></u>'''<sup></sup>
'''<u></u>'''<sup></sup>


=== Strengthening ===
== Clinical Bottom Line ==
* Prone Horizontal Abduction: Lie on stomach with arm hanging over side of table and the thumb facing forward. Slowly raise arm straight out to the side and stop when arm is parallel to the body (going higher can cause excessive strain to the front of the shoulder).<ref name=":9">Exercises to Strengthen the Rotator Cuff Muscles in the Shoulder, http://www.physioroom.com/experts/asktheexperts/answers/qa_mb_20050225.php (accessed on June 6) (level of evidence 5)</ref> (LoE 5)
* Prone Row with External Rotation: Begin in the same position as above, except rotate your hand so the thumb is facing towards the body. Perform a rowing motion with the elbow in the same plane as the shoulder, and stop when the elbow is even with the shoulder. After achieving this position, rotate the arm upwards until the forearm is just below parallel with the body. Next, rotate the forearm back down to the previous position, and then lower the arm back down to the starting position.<ref name=":9" /> (LoE 5)
* Horizontal Abduction with Thera-tubing<br>Stand facing toward the attachment site of the tubing (attached to the door or wall at the height of the chest), with the arm extended straight out in front of you. Slowly pull arm backwards and out to the side, keeping the arm at shoulder height. As you perform this motion, try to pinch the shoulder blade backwards/inwards.<ref name=":9" /> (LoE 5)
 
*
 
== Resources ==
* [https://emedicine.medscape.com/article/93095-differential Supraspinatus tendonitis differential diagnoses]
* [https://emedicine.medscape.com/article/92814-clinical Rotator cuff injuries clinical presentation]
* [https://www.sportsinjuryclinic.net/shoulder-pain/acute-shoulder-injuries/rotator-cuff-strain Rotator cuff tear]
 
== Clinical bottom line ==
 
Timing of Surgical Intervention: Evidence is too limited to draw conclusions about the comparative effectiveness of early surgical repair when compared to late surgical repair following nonoperative interventions.<br>Operative vs. Nonoperative Interventions*: Significant improvements were seen in all study groups regardless of the intervention. Although there was a trend for better outcomes with surgery, results were too limited to permit conclusions.<br>Nonoperative Interventions: The variety of interventions and the low quality of studies precludes any conclusions about the most effective nonoperative patient-management strategy.<br>Operative Interventions: Functional outcomes were similar for open vs. mini-open repair; mini-open vs. arthroscopic repair; open or mini-open vs. arthroscopic repair; and arthroscopic repair with or without acromioplasty. However, exceptions were:<br>Mini-open vs. open repair: Patients may return to work or sports approximately 1 month earlier if they have a mini-open repair (p &lt; 0.00001). <br>Open repair vs. open or arthroscopic debridement: Open repair results in greater improvement in functional outcomes than does debridement (p ≤ 0.03). <br>Postoperative Rehabilitation: Overall, patients improved over the course of postoperative followup. However, there was not enough quality evidence to determine the optimal postoperative rehabilitation protocol.<br>Adverse Events: In general, complication rates were low for clinically important complications such as re-tears, stiffness, infection, and neurological injury.<br> Nonoperative comparators included shock-wave therapy, steroid injection, physical therapy, modified activity, oral medication, passive stretching, and strengthening. Operative interventions included mini-open, open, arthroscopic debridement, or open repair with acromioplasty.<br>Nonoperative interventions included stretching and strengthening, steroid injections, and oral medications.<br>Postoperative rehabilitation interventions usually included an unspecified physical therapy component; however, the comparisons varied across studies.
*


A supraspinatus tear can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear.<ref name=":0" /> Most of the time, the tear occurs in the tendon or as an avulsion from the greater tuberosity<ref name=":6" />. The tear can be partial or full-thickness. Pain, loss of range of motion and weakness is the 3 most common symptoms.<ref name=":0" /><ref name=":11" /><ref name=":13" /> Supraspinatus tears can be managed conservatively, with NSAID's and physiotherapy, as well as surgically to repair the tear. 
== References ==
== References ==
<references />
[[Category:Shoulder]]  
[[Category:Shoulder]]  
[[Category:Shoulder_Conditions]]  
[[Category:Conditions]]
[[Category:Shoulder - Conditions]]  
[[Category:Sports_Injuries]]
[[Category:Sports_Injuries]]
<references />
[[Category:Sports Medicine]]
[[Category:Sports Medicine]]

Latest revision as of 13:32, 22 May 2023

Original Editor - Brecht Haex

Top Contributors - Kim Jackson, Leana Louw, Mats Vandervelde, Brecht Haex, Fasuba Ayobami, Vidya Acharya, Habibu Salisu Badamasi, Wendy Walker, Naomi O'Reilly, Saimat Lachinova, Simisola Ajeyalemi, Wout Van Hees, Joao Costa, Shreya Pavaskar, Rachael Lowe, Anthony Mertens and Wanda van Niekerk

Definition/Description[edit | edit source]

Supraspinatus muscle (highlighted in green) - posterior view

A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle. The supraspinatus is part of the rotator cuff of the shoulder. Most of the time, it is accompanied by another rotator cuff muscle tear. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear.[1] Quite often, the tear occurs in the tendon or as an avulsion from the greater tuberosity.[2]

Image: Supraspinatus muscle (highlighted in green) - posterior view[3]

Clinical Relevant Anatomy[edit | edit source]

The shoulder joint is made up of three bones: the humerus, scapula and clavicle. The head of the humerus and the glenoid of the scapula form a ball-and-socket joint[1]. The supraspinatus muscle is located on the back of the shoulder, forming part of the rotator cuff. The rotator cuff consists of Supraspinatus, Infraspinatus, Subscapularis and teres minor. The rotator cuff covers the head of the humerus and keeps it in place. These muscles help to lift and rotate the arm. Visit the shoulder for more detailed information.

Muscles of the scapular region anterior aspect Primal.png

Supraspinatus[edit | edit source]

  • Origin: Supraspinous fossa of the scapula
  • Insertion: Greater tubercle of the humerus
  • Innervation: Supraspinatus nerve (C5-C6)
  • Function: Abduction of the glenohumeral joint; assists the rotator cuff in stabilizing, control and movement the shoulder; assists in preventing subluxation at the shoulder

[1][4][5]

Epidemiology/Aetiology[edit | edit source]

The aetiology of supraspinatus tears is multifactorial, consisting of age-related degeneration, microtrauma, and macrotrauma. It mostly affects the dominant arm with about 50% of people in their 80s experiencing this condition. [6][7] Injury and degeneration are the two main causes of rotator cuff tears. Rotator cuff tears are associated with older patients, those with a history of trauma and mostly affect the dominant arm.

Mechanism of Injury[edit | edit source]

Acute tear: Can occur with other shoulder injuries (e.g. clavicle fracture of shoulder dislocation)

  • Fall on an outstretched arm
  • Lifting something too heavy

Degenerative: Wear and tear of the tendon slowly over time

  • Increases with the age
  • More common in the dominant arm
  • When you have a degenerative tear in one shoulder, you have a greater risk for a tear in the opposite shoulder, even if you have no pain in the opposite shoulder.

Risk Factors[edit | edit source]

  • > 40 years old
  • Male > Female
  • Smoking
  • Genetics
  • Hypercholesterolemia
  • Body mass index
  • Height
  • Repetitive stress/lifting
  • History of trauma
  • Lack of blood supply
  • Bony spurs
  • Overhead activities and other people who do overhead work: Tennis players, Baseball pitchers, Painters, Carpenters, and Plumbers.
  • Traumatic injury e.g. fall (more common cause in younger individuals)[1]

Characteristics/Clinical presentation[edit | edit source]

Supraspinatus tears are normally present as partial or full-thickness tears. It can be asymptomatic or symptomatic.

Partial thickness:

  • Incomplete disruption of muscle fibres[1]
  • Can progress to complete tear - Increasing pain is normally the first sign of the progression of a tear

Full thickness: Complete disruption of muscle fibres

  • Large tears (1-1,5cm) have a high rate of progression
  • If progression is suspected in conservatively managed cases - further investigation is warranted
  • Smaller tears (<1cm) progress slower

[6][7]

Signs and Symptoms[edit | edit source]

Patients normally present with:[1][7][8]

  • Pain/worsening pain (in cases where tears are progressing), the most common symptoms are:
  • Pain when lifting and lowering your arm or with specific movement
  • Pain at rest
  • Pain at night, predominantly when you lie on the affected shoulder
  • Traumatic tears: Sudden, intense pain often accompanied by a snapping sensation and immediate weakness in the upper arm
  • Located anterolaterally and superiorly
  • Referred to the level of the deltoid insertion with full-thickness tears
  • Repetitive strain tear: Starts off mild and only when lifting your arm; over time the pain can become more noticeable at rest
  • Aggravated in overhead or forward-flexed position
  • Limited range of motion
  • Reduced forward elevation, external rotation and abduction
  • Struggle with activities like reaching behind back, combing hair and overhead activities
  • Stiffness
  • Weakness when rotating or lifting your arm
  • Crepitus, Clicking, and Instability

Differential Diagnosis[edit | edit source]

[9][10]

Diagnostic Procedures[edit | edit source]

Physical Examination[edit | edit source]

Subjective interview:[edit | edit source]

  • Onset: Spontaneous or after injury
  • Duration of pain
  • Pain provocation/aggravating factors
  • Night rest
  • Same problems in the past?
  • Activity limitations
  • Localize pain
  • Past medical history
  • Recreational or sport activities (possible overhead activities)

Observation:[edit | edit source]

    • Any atrophy present

Range of motion:[edit | edit source]

  • Expect reductions in flexion, abduction and external rotation
  • If passive abduction range is more than active range, it is an indication of a rotator cuff tear

Muscle power:[edit | edit source]

  • Test supraspinatus by resisting abduction at 90° and internal rotation
  • Scapular movement may be affected

Palpation:[edit | edit source]

  • Forearm behind back to palpate rotator cuff just anterior and below the acromion
    • Muscle atrophy present
    • Tenderness

Special tests:[edit | edit source]

  • Drop-arm test: Active shoulder abduction to 90°, then return [11]
    • Positive: Dropping the arm down with pain indicates a positive test

Drop Arm Test video provided by Clinically Relevant


  • Jobe/supraspinatus/empty can test: Resist shoulder abduction and internal rotation[11]
    • Positive: Pain/weakness

Empty Can Test video provided by Clinically Relevant

  • Full can test: Resisted shoulder abduction in external rotation
    • Positive: Pain/weakness

Full Can Test video provided by Clinically Relevant

  • Subacromial grind test: Patient standing and examiner standing facing the patient, the examiner grasps the patient's flexed elbow. The shoulder is passively abducted in the scapular plane to 90°. The examiner's other hand is placed over the patient's shoulder overlying the anterior acromion and greater tuberosity. The examiner passively internally and externally rotates the shoulder detecting the presence of palpable crepitus.
    • Positive: Palpable crepitus.[12]

[13][14]

Special Investigations[edit | edit source]

X-rays[edit | edit source]

  • Excluding sclerosis and osteophyte formation on the acromion
  • X-rays measure the size of the subacromial space
  • Unable to see the tendon
Supraspinatus tear as seen in radiographics

MRI[edit | edit source]

  • MRI Scan shows partial or full tears in the tendons of the rotator cuff, inflammation to weak structures and cracks in the capsule

CT Scan[edit | edit source]

  • CT scan is able to localize tendon when patient positioned with forearm behind the back

Ultrasound[edit | edit source]

Outcome Measures[edit | edit source]

Medical Management[edit | edit source]

Conservative Management[edit | edit source]

Indications:[6][7]

  • Older (>70 years) patients with a chronic tear
  • Patients with irreparable tears with irreversible changes
  • Patients of any age with small (<1 cm) full-thickness tears
    • As a result of the slow rate of progression of these tears
  • Patients without a full-thickness tear

Management includes:[15]

NSAID's:

  • Ibuprofen

Corticosteroid injections:

  • Eliminate pain for a period of time, making physiotherapy management easier
  • Tendon tissue can be weakened by these injections (which would have an adverse effect on the outcome of a possible surgery)
  • Limited to 2 injections
  • Physiotherapy (see Physiotherapy management below)

Surgical Management[edit | edit source]

Indications:[6][7][16]

  • Failed conservative management
  • Larger symptomatic full-thickness tears (1-1,5cm) as a result of the high rate of progression. Should be considered for earlier surgical repair in younger patients if the tear is repairable and the muscle degeneration is limited
  • Acute large tears (>1 cm-1.5 cm) or
  • Young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes
  • Complete tear with significant pain and dysfunction after 6 months of treatment
  • Repeated dislocations

Rotator cuff repair[edit | edit source]

Most repairs are done arthroscopically[16]. Severity (partial vs full-thickness) will determine the approach.

  • Partial repair: The tendon and surrounding bone will be smoothed to avoid further damage and therefore allowing the tendon to heal mostly on its own[17]
  • Complete tear: Tear in middle of tendon: Suture the two parts of the tendon back together. Tear close or on its point of attachment on the head of the humerus: Attach the tendon back to its original place by an anchor (sometimes two). This anchor actually consists of a small screw that is bored into the head of the humerus with on the back surgical wires which hold the tendon in place[18].

Physiotherapy Management[edit | edit source]

Physiotherapy management depends on the extent of the tear, and plays in important role in both conservative management as well as post-surgical rehabilitation. More details can also be obtained from the rotator cuff page.

Conservative Management[edit | edit source]

Physiotherapy goals:

  • Improve pain together with NSAID’s (2-6 weeks)
  • Cryotherapy (only in first 48 hours)
  • Massage
  • Improve circulation (to control inflammation and speed up the healing process)
  • Improve range of motion:
    • Stretching (careful with timing, as stretching of acute injury may aggravate the tear):[19] 
      • Crossover arm stretch: 12 seconds, 5 times a day; 5-6days/week 

4.png

Kristian Berg. Prescriptive stretching; Human Kinetics [20]

  • Door stretch: 5 x 30 seconds (5 second rest in between)
  • Passive/Active range of motion:[21]
    • Pendulum exercises: Forward and back, side-to-side, circular motion. 2 sets of 10 a day, 5-6days/week
    • Symptom limited active-assisted range of motion exercises

5.png

Kristian Berg. Prescriptive stretching; Human Kinetics [20]

  • Increase strength:[22][23]
    • Rotator cuff (especially supraspinatus) strengthening to improve muscle control and strength
    • Prone Horizontal Abduction progress by using resistance bands
    • Prone Row with External Rotation
  • Regain function of affected upper limb (up to 3 months)
  • Home exercise programme

Clinical Bottom Line[edit | edit source]

A supraspinatus tear can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear.[1] Most of the time, the tear occurs in the tendon or as an avulsion from the greater tuberosity[2]. The tear can be partial or full-thickness. Pain, loss of range of motion and weakness is the 3 most common symptoms.[1][7][8] Supraspinatus tears can be managed conservatively, with NSAID's and physiotherapy, as well as surgically to repair the tear.

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 American Academy of Orthopedic Surgeons, Ortho Info. Rotator cuff tears, http://orthoinfo.aaos.org/topic.cfm?topic=a00064 (accessed 29/08/2018).
  2. ↑ 2.0 2.1 Benazzo F, Marullo M, Pietrobono L. Supraspinatus rupture at the musculotendinous junction in a young woman. Journal of Orthopaedics and Traumatology 2014;15(3):231-4.
  3. ↑ Supraspinatus muscle (highlighted in green) - posterior view image - © Kenhub https://www.kenhub.com/en/library/anatomy/supraspinatus-muscle
  4. ↑ Schünke M, Schulte E, Schumacher U, Voll M, Wesker K. Prometheus: Algemene anatomie en bewegingsapparaat, 2010. p600.
  5. ↑ Physioworks, Rotator Cuff Tear.http://physioworks.com.au/injuries-conditions-1/rotator-cuff-tears (accessed 29/08/2018).
  6. ↑ 6.0 6.1 6.2 6.3 Tashjian RZ. Epidemiology, natural history and indications for treatment of rotator cuff tears. Clinics in Sports Medicine 2012:31(4):589-604.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. Journal of shoulder and elbow surgery 2010:19(1):116-20.
  8. ↑ 8.0 8.1 Mayo Clinic Rotator cuff injury. http://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/dxc-20126923 (accessed 30/08/2018).
  9. ↑ Medscape. Supraspinatus tendonitis: Differential diagnoses, http://emedicine.medscape.com/article/93095-differential (Accessed 20/03/2015).
  10. ↑ Medscape. Rotator cuff injury: Differential diagnoses, http://emedicine.medscape.com/article/92814-differential, (Accessed 25/03/2015).
  11. ↑ 11.0 11.1 Hughers PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Aust J Physiother 2008;54(3):159-70.
  12. ↑ Sawalha S, Fischer J. The accuracy of “subacromial grind test” in diagnosis of supraspinatus rotator cuff tears. International journal of shoulder surgery 2015;9(2):43-46.
  13. ↑ Walters J, editor. Orthopaedics - A guide for practitioners. 4th Edition. Cape Town: University of Cape Town, 2010.
  14. ↑ Orthop J. Rotator cuff tear: physical examination and conservative treatment. Department of Orthopaedic Surgery Tohoku University, 2013:197–204.
  15. ↑ Björkenheim JM, Paavolainen P, Ahovuo J, Slätis P. Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results. Clinical orthopaedics and related research 1988;(236):148-53.
  16. ↑ 16.0 16.1 Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clinical orthopaedics and related research 2009;467(4):966-78.
  17. ↑ American Academy of Orthopedic Surgeons. Rotator Cuff Tears: Surgical Treatment Options. https://orthoinfo.aaos.org/en/treatment/rotator-cuff-tears-surgical-treatment-options/ (accessed 30/08/2018).
  18. ↑ Akpınar S, Uysal M, Pourbagher MA, Ozalay M, Cesur N, Hersekli MA. Prospective evaluation of the functional and anatomical results of arthroscopic repair in small and medium-sized full-thickness tears of the supraspinatus tendon. Acta orthopaedica et traumatologica turcica 2011;45(4):248-53.
  19. ↑ Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Journal of shoulder and elbow surgery 2009;18(1):138-60.
  20. ↑ 20.0 20.1 Kristian Berg, Human Kinetics:. Prescriptive stretching. 2011.
  21. ↑ Joseph Berman MD. Supraspinatus tear, http://www.josephbermanmd.com/diagnosis-treatament-of-the-shoulder/rotator-cuff-tear/ (accessed 29/04/2015).
  22. ↑ Physioroom. Exercises to Strengthen the Rotator Cuff Muscles in the Shoulder.http://www.physioroom.com/experts/asktheexperts/answers/qa_mb_20050225.php (accessed 31/08/2018).
  23. ↑ Heers G, Anders S, Werther M, Lerch K, Hedtmann A, Grifka J. Efficacy of home exercises for symptomatic rotator cuff tears in correlation to the size of the defect. Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin 2005;19(1):22-7.
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