Supraspinatus tendinosis

Recreational or professional athlete, there is always a chance that we may have overexerted ourselves after one training session or a long weeks’ worth of training. Or perhaps, we took a long break from regular gym regimes and we jumped back straight into heavy overhead lifting. Being overzealous with exercise, overhead lifting or even manual jobs that require repetitive overhead work may place us at a risk of contracting a supraspinatus tendinosis.

What is it?

The supraspinatous tendon is one of 4 rotator cuffs that may be strained or teared. While that is true, there is another bracket of injuries called a tendinosis. This is when the muscle becomes thick due to repetitive use and has not been left adequate time to recover. The result is an increase in dysfunctional protein development and focal thickening of the tendon itself. The tendon then presses up within other bony structures of the shoulder leading to sharp pain within normal shoulder range of motion.

Signs and symptoms

Painful arc when we bring out shoulders up or to the side.
Impingement symptoms (intense sharp pain)
Enlarged/inflamed supraspinatous tendon
Local tenderness over shoulder
Referred or pain radiating to the lateral upper arm/tip of the shoulder
Pain on overhead lifting or overhead activities (load – dependent nature)
nil pain in resting state

Risk Factors

Overuse of the shoulder – repetitive sport injuries (throwing a ball – baseball, cricket, swimming)
Acute trauma (car accidents)
Muscle imbalance

Essentially extrinsic risk factor is is founded in training volume, the novelty of training and frequency; while the intrinsic risk factors can be attributed to shortened/tight muscle length, nuance arm discrepancies, altered kinematics while performing various tasks (i.e spiking in volleyball, bowling in cricket, overhead pressing, etc)

Solution

The solution to all muscle tendinosis involves a heavy eccentric loading program to wean the muscle back into normal function. These types of injury will not heal with relative rest contrary to popular belief around muscular injuries. What we need to do is encourage the right specific type of training to rectify the underlying protein issues within the muscle. When it comes to prognosis, all tendinopathies are frustratingly difficult to manage. This is because the patient has to strike a balance between efficient collagen turnover within the tendon without encouraging overproduction of dysfunctional collagen. However if this balance is achieved, then it could take a little as 4 to 6 weeks (as a rough ballpark) to overcome this injury.

The only solution to all tendinopathies is exercise. Other alternative management may have beneficial implications on pain, however these are transient solutions. Also be mindful that

There are 4 stages to healing any tendinopathy:

STAGE ONE: ISOMETRIC LOADING

Arm isometrics for pain relief – 3 x 10 (holding for 20 seconds) pressing your arms forwards, or to the side (flexion and abduction).
Pain needs to be 3/10 or less; and settle within 24 hours otherwise the load tolerance has been exceeded
Passive range of motion.

STAGE TWO: ISOTONIC LOADING – restoring muscle strength in functional range of movement without pain > 5/10

Slow range of motion – pressing down onto a chair 3 x 10
Theraband pull downs (from overhead) at 45 degrees 3 x 10
Full can exercise with theraband/1kg weight 5 x 15 (pain should not be greater than
Strengthening in PNF d1 and d2 patterns upper extremity (with 1kg weight) 3 x 15
Theraband external rotation and internal rotation for general rotator cuff maintenance

STAGE THREE: ENERGY STORAGE LOADING – Advised when the patient can tolerate all of the above exercises with <3/10 pain

3 x 10 overhead shoulder press, bench press, push jerk

STAGE FOUR: RETURN TO SPORT

Sport specific training, practicing spiking, bowling and more complex overhead lifts.

Conclusion

All tendinosis are painfully annoying and should seek professional help immediately before the issue progresses and continues to degenerate. These issues are amenable through specific shoulder exercises and a correct rate of progressing shoulder exercises.

Article by Joshua Shum (Physiotherapist)